Case Manager, Registered Nurse
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Job Description
Remote RN Case Manager coordinating telephonic and face-to-face care for CVS Health members. Assessing medical needs, benefits, risks, and wellness outcomes.
Responsibilities:
- Telephonically and/or face to face assess, plan, implement, and coordinate case management activities with members
- Evaluate members’ medical needs to facilitate overall wellness
- Collaboratively develop proactive courses of action to improve short- and long-term outcomes
- Review clinical tools and information/data, including assessments and claims
- Evaluate member needs and available benefits and refer members to plan sponsor programs
- 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 between 8:30 a.m. and 5:00 p.m. in the employee’s time zone for a scheduled 8-hour shift
- Potentially work weekends and holidays on an on-call, volunteer basis
- Travel less than 5% for on-site meetings, trainings, system updates, or licensure requirements
Requirements:
- Must have an active current and unrestricted RN license in state of residence
- Candidates in a Nurse Licensure Compact jurisdiction must be able to use their compact license without restriction
- Willingness and ability to obtain additional state licenses upon hire
- 3+ years of acute care clinical experience as an RN, including general medical, post-surgical, specialty, pediatrics, ICU, case management or discharge planning
- Ability to use a computer station with multiple screens, operate multiple programs simultaneously, and sit for extended periods
- Private designated workspace free of distractions and 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 and private designated home virtual work location compliant with CVS Health and HIPAA guidelines
- Ability to work within the state and city where currently residing
- Ability to obtain required internet speeds and adhere to Work From Home requirements
- Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously
- Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings
- Experience with Microsoft Office 365 applications or similar Google Workspace applications
- Ability to log in to secure systems such as VPN and EHR portals, lock computer screens, manage strong passwords, and recognize suspicious emails or links
- Ability to troubleshoot common technical issues independently
- Openness to learning new skills as the workplace evolves
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, headset, etc.
- Additional state licenses paid for by the company
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