Case Manager, Registered Nurse
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Remote RN Case Manager assessing members and coordinating care plans for CVS Health. Supporting wellness through clinical judgment, benefits review, and case management.
Responsibilities:
- Assess members telephonically and/or face to face
- Plan, implement, and coordinate case management activities
- Evaluate members’ medical needs to facilitate overall wellness
- Collaboratively develop proactive courses of action to improve short- and long-term outcomes
- Review clinical tools, assessments, claims, and other data to evaluate member needs and available benefits
- Collaborate with and refer members to programs offered by plan sponsors
- Apply clinical judgment to reduce risk factors and address complex health issues and social indicators
- Use case management processes in compliance with regulatory and company policies and procedures
- Use interviewing skills to maximize member engagement and determine health status and needs
- Work Monday through Friday during scheduled 8-hour shifts between 8:30 a.m. and 5:00 p.m. in the employee’s time zone
- Potentially work weekends and holidays on an on-call, volunteer basis
- Travel less than 5% for on-site meetings, training, system updates, or licensure requirements
Requirements:
- Active, current, and unrestricted RN license in the state of residence
- Ability to use a compact RN license without restriction if located within the Nurse Licensure Compact jurisdiction
- Willingness and ability to obtain additional state licenses upon hire
- 3+ years of acute care clinical experience as an RN
- Ability to use a computer station with multiple screens and operate multiple programs simultaneously
- Ability to sit for extended periods of time
- Private designated workspace free of distractions
- High-speed internet
- Associate Degree in Nursing required
- Direct/hardwired internet connection to a modem/router within 7 feet of the computer
- Minimum internet speed of 25 Mbps download and 3 Mbps upload
- Quiet, secure, private, and HIPAA-compliant home workspace
- Ability to work within the state and city where currently living
- Experience with multiple monitors and multiple applications
- Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings
- Experience with Microsoft Office 365 applications or similar tools such as Google Workspace
- Ability to access secure systems such as VPN and EHR portals
- Ability to follow computer security practices, manage strong passwords, and recognize suspicious emails or links
- Ability to resolve common technical issues independently
- Preferred: Compact RN licensure
- Preferred: 1+ years of case management experience
- Preferred: Certified Case Manager (CCM) certification
- Preferred: Experience with Microsoft PowerPoint, Excel, and Word
- Preferred: Strong telephonic communication skills
- Preferred: 1+ years of experience using computers and navigating multiple monitors while speaking on the telephone
Benefits:
- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- Company-provided equipment including keyboard, monitor, computer, and headset
- Additional state licenses paid for by the company
Similar Jobs
Case Manager, Registered Nurse
Remote RN Case Manager coordinating CVS Health members’ clinical care, benefits, and wellness. Assessing needs and managing care through telephonic and face-to-face member engagement.
Case Manager, Registered Nurse
Remote RN Case Manager coordinating telephonic and face-to-face care for CVS Health members. Assessing medical needs, benefits, risks, and wellness outcomes.
Clinical Review Nurse – Concurrent Review
Clinical Review Nurse conducting concurrent utilization reviews for Centene’s Medicaid and Ambetter members. Evaluating medical necessity, care levels, and discharge planning remotely.
Utilization Review Nurse
Utilization Review Nurse reviewing emergency admissions and continued stays using InterQual or MCG criteria. Supporting authorization decisions and appropriate healthcare resource utilization at Netsmart.
Registered Nurse, Case Manager, Care Coordination
RN case manager coordinating patient-centered care for Geisinger Health Plan. Assessing needs, developing care plans, and optimizing clinical, quality, and fiscal outcomes.
Virtual Oncology Nurse Navigator
Virtual oncology nurse navigator delivering triage, education, and care coordination. Supporting Daymark Health’s personalized cancer care platform through phone and virtual care.
National Virtual Oncology Nurse Navigator
National virtual oncology nurse navigator providing triage, care coordination, and patient education. Supporting Daymark Health’s value-based cancer care platform through virtual patient care.
Mobile Nurse – Healthcare Professional
Mobile nurse conducting venous blood draws and workplace health screenings for HealthCaters. Event-based assignments at company locations across Germany, with occasional European opportunities.
Clinical Trial Nurse Navigator – Grant Funded
Clinical Trial Nurse Navigator helping blood cancer patients identify and enroll in clinical trials at Blood Cancer United. Educating families on treatment options and supporting informed care decisions.
Registered Nurse Care Manager
Registered Nurse Care Manager coordinating assessments, authorizations, and care plans for CareSource members. Mobile role serving Brooklyn homes and care settings with extensive travel.
Clinical Review Nurse – Concurrent Review, NICU
Clinical Review Nurse conducting concurrent NICU reviews for Centene’s Medicaid and marketplace members. Evaluating medical necessity, care levels, and discharge planning remotely.
Utilization Management Nurse
Utilization Management Nurse coordinating medical services and benefit determinations for Humana, a U.S. healthcare and insurance company. Applying clinical criteria to support optimal member care.
Registered Nurse, Virtual Hiring Event
Registered Nurse hiring event for Wellstar MCG Health in Augusta, Georgia. Exploring acute, critical, emergency, labor and delivery, pediatric, and neonatal care opportunities.
Nurse Navigator – FIND Program
Remote Nurse Navigator coordinating follow-up for patients with incidental radiological findings. Supporting Trinity Health care teams through education, referrals, and care navigation.
Triage Registered Nurse, Hospice
Part-time remote hospice triage RN assessing patients by phone and coordinating palliative care. Sequoia Hospice serves patients and families through home health and hospice services.
Medical Insurance Specialist – Registered Nurse
Remote Registered Nurse verifying U.S. insurance benefits and managing eClinicalWorks scheduling. Driving patient engagement and appointment conversions for an orthopedic, pain medicine, and PM&R practice.
Travel Flight Nurse
Travel Flight Nurse delivering critical helicopter patient care for Air Methods. Assessing, treating and transporting patients on rotating 14-day assignments.
Freelance Research Nurse
Freelance research nurse supporting Illingworth’s patient-focused clinical research services. Conducting trial visits, medication administration, sample handling, and adverse-event reporting in Lille, France.
Clinical Care RPM LVN
Remote LVN/LPN managing RPM alerts, wellness assessments, and high-volume patient calls. Supporting Nsight Health’s technology-enabled chronic-care platform through telephonic clinical interventions.
Registered Nurse
Registered Nurse reviewing OASIS assessments and ICD-10 coding for Caringhand Home Health Solutions’ California home health patients. Supporting compliance, documentation quality, and clinical outcomes remotely.