Case Manager Registered Nurse

CVS Health

1d • $54,095 - $116,760 • Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. This is a full-time telework position with less than 5% travel required. The schedule for this role is Monday-Friday 8:30a-5p in time zone of residence. Position Summary This RN Case Manager position is remote and candidates can apply from any state but must work the stated hours. There is a preference for nurses in a compact RN licensure state, however, that is not required. The RN Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate overall wellness. Collaboratively develops a proactive course of action to address issues presented to enhance the short and long term outcomes as well as opportunities to enhance a member’s overall wellness through integration. Through the use of clinical tools and information/data review (e.g., assessments, claims, etc.) conducts an evaluation of member’s needs and available benefits to collaborate and refer to programs offered by the plan sponsor. Applies clinical judgment to reduce risk factors, address complex health issues and social indicators. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation. A private designated workspace free of distractions and high-speed internet

Requirements

• Must have an active current and unrestricted RN license in state of residence. If located within the Nurse Licensure Compact jurisdiction, the ability to use their compact license without restriction
• Must be willing and able to obtain additional state licenses as needed
• 5+ years of acute care clinical experience as an RN (general medical, post-surgical, specialty including pediatrics, ICU, case management and discharge planning)
• 1+ year(s) of experience utilizing computers and navigating multiple monitors while speaking with someone on the telephone
• 1+ year(s) of experience with all Microsoft Office Suite applications
• Must be willing and able to work Monday through Friday between the hours of 8:30am – 5:00pm in applicant's time zone for a scheduled 8-hour shift. Weekends and holidays may be required per the needs of the department. Currently, both weekends and holidays are on-call only and covered on a volunteer basis
• Must be willing and able to travel less than 5% for on-site meetings, trainings, or system updates, or to meet licensure requirements e.g., finger printing
• A private designated workspace free of distractions and high-speed internet

Nice To Haves

• Compact RN licensure
• 1+ year(s) of case management experience
• Certified Case Manager (CCM) certification
• Strong customer service skills including attention to customers, sensitivity to certain issues and proactive identification/resolution of issues
• Strong telephonic communication and organizational skills
• Excellent critical thinking skills
• BSN preferred

Responsibilities

• telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate overall wellness
• Collaboratively develops a proactive course of action to address issues presented to enhance the short and long term outcomes as well as opportunities to enhance a member’s overall wellness through integration
• Through the use of clinical tools and information/data review (e.g., assessments, claims, etc.) conducts an evaluation of member’s needs and available benefits to collaborate and refer to programs offered by the plan sponsor
• Applies clinical judgment to reduce risk factors, address complex health issues and social indicators
• Utilizes case management processes in compliance with regulatory and company policies and procedures
• Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation

Benefits

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree