Case Manager, Registered Nurse
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Remote CVS Health Registered Nurse coordinating case management, care plans, and resources for chronically ill and catastrophic Medicare members. Supporting wellness, outcomes, and return to work.
Responsibilities:
- Assess, plan, facilitate, coordinate, evaluate, and advocate for services addressing members’ and families’ comprehensive health needs
- Act as liaison among members/clients, families, employers, providers, insurers, attorneys, and healthcare personnel
- Coordinate case management activities for catastrophic cases and chronically ill Medicare members across the continuum of care
- Arrange consultant referrals, home care visits, community resources, and alternative levels of care
- Interact with members/clients telephonically or in person, including possible visits to homes, worksites, or physician offices
- Assess medical and vocational status and develop plans of care to optimize wellness, medical outcomes, functioning, and return to work
- Communicate with members/clients and stakeholders regarding care and treatment
- Prepare required case work documentation and reports
- Consult with internal multidisciplinary teams
- Contact treating physicians and specialists regarding care and treatment
- Provide education and prevention information
- Apply laws, regulations, insurer instructions, and company policies governing rehabilitation and case management services
- Testify as required to substantiate case work or reports
- Evaluate needs and benefit-plan eligibility using clinical tools and data
- Monitor member/client progress toward desired outcomes through assessment and evaluation
- Develop proactive courses of action to improve short- and long-term outcomes and overall wellness
Requirements:
- Candidate must reside in the South Region: OH, VA, NC, KY, TN, SC, GA, AL, MS, AR, LA, FL
- Willingness to work Monday–Friday, 8:00am–5:00pm EST
- Active and unrestricted Compact Registered Nurse (RN) Licensure in OH or in the candidate’s state of residence
- 3+ years clinical practical experience, preferably with diabetes, CHF, CKD, post-acute care, hospice, palliative care, or cardiac experience with Medicare members
- 2+ years case management, discharge planning and/or home health care coordination experience
- Associate's Degree or Nursing Diploma required
- 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 (Teams, Outlook, Word, Excel, PowerPoint) or similar Google Workspace applications
- Ability to log in to secure systems such as VPN and EHR portals
- Ability to maintain strong passwords, lock computer screens when unattended, and recognize suspicious emails or links
- Ability to resolve common technical issues independently
- Ability to obtain required internet speeds and comply with Work From Home requirements
- Quiet, secure, private designated home work location compliant with CVS Health and HIPAA guidelines
- Direct/hardwired internet connection within 7 feet of the computer with minimum 25 Mbps download and 3 Mbps upload speeds
- Bachelor's Degree preferred
- Bilingual Spanish preferred
- National professional certification (CRC, CDMS, CRRN, COHN, or CCM) preferred
- Excellent analytical and problem-solving skills preferred
- Effective communication, organizational, and interpersonal skills preferred
- Ability to work independently preferred
- Openness to learning new skills preferred
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.
- Company-provided multi-state RN licenses if needed
- Comprehensive benefits package for eligible full-time colleagues
Similar Jobs
Quality Nurse
Quality Nurse supporting NAPA’s anesthesia quality improvement, reporting, and regulatory compliance programs. Monitoring clinical data, educating clinicians, and traveling to clinical sites as needed.
Clinical Triage Nurse, RN
Remote Clinical Triage Nurse, RN assessing patient calls and test results for HarmonyCares’ in-home primary care services. Coordinating care, advising patients, and supporting providers.
Nurse Advisor, RN
Nurse Advisor guiding U.S. patients through complex healthcare decisions, advocacy, and care coordination. Supporting low- to moderate-acuity cases and triaging new clients for Private Health Management.
Appeals Nurse
Registered Nurse reviewing medical necessity and Medicare appeal cases for WPS, a nonprofit health insurer and federal government contractor. Preparing clinical rationales and guiding timely CMS-compliant redeterminations.
LPN
Preventive Care LPN delivering in-home screenings, blood pressure checks, and specimen collection. Supporting CenterWell’s personalized home healthcare through accurate EMR documentation.
Nurse Specialist II
Nurse Specialist II reviewing Medicare and Medicaid records and claims for Qlarant, a healthcare-programs nonprofit. Identifying overpayments, fraud, waste, and abuse through audits and investigations.
Nurse
Remote Nurse managing patient messages, routine clinical inquiries, and follow-ups for LumiMeds’ U.S. telehealth weight-management platform. Escalating complex concerns and maintaining HIPAA-compliant documentation.
Utilization Management Nurse
Utilization Management Nurse reviewing authorizations, hospital stays, and transitions for Curana Health’s value-based senior healthcare programs. Supporting quality outcomes and cost-effective care remotely.
Oncology Administrative Nurse
Remote oncology administrative nurse processing prescriptions and refill requests for Adjuvant Behavioral Health. Supporting patient care plans and medication oversight for oncology patients, families, and caregivers.
Care Coordinator – LPN/LVN
Care Coordinator/LPN supporting patients, families, and providers in Empassion’s palliative care program. Coordinating appointments, clinical documentation, triage, and follow-up remotely.
Case Manager, Registered Nurse
Remote RN case manager at CVS Health, coordinating personalized care and discharge planning for members nationwide. Advocating for access, quality outcomes, and cost-effective healthcare.
Research Nurse – Per Diem Independent Contractor
Part-time research nurse conducting mobile clinical-trial visits for Illingworth Research Group. Administering trial medication, collecting samples, and maintaining GCP-compliant study data.
Home Infusion Registered Nurse, PRN
PRN Home Infusion RN administering specialty medications and monitoring patients in their homes. Supporting CSI Pharmacy’s specialty care services across the Las Vegas area.
Registered Nurse
Registered Nurse supporting patients through Mosh & Moshy’s Australian digital health platform. Delivering telehealth assessment, triage, education and care coordination remotely.
Veterinary Nurse
Veterinary Nurse providing surgical, anaesthetic, medical, and hospital care at Greencross Vets Mount Gravatt. Supporting veterinarians, patients, clients, and daily clinic operations.
Behavioral Health Licensed Practical Nurse, LPN
Remote behavioral health LPN coordinating admissions, clinical screening, and patient transfers. Supporting Lifepoint Health facilities through triage, compliance, and patient-flow management.
Utilization Review Nurse
Utilization Review Nurse conducting remote workers’ compensation utilization reviews. Evaluating medical necessity, coordinating discharge planning, and referring cases for case management.
Registered Nurse, CA RN License Required
Remote Registered Nurse delivering virtual geriatric primary care for Pine Park Health. Coordinating assessments, triage, care plans, and chronic-care support for senior living residents.
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.