Case Manager Registered Nurse

Position Summary

Case Manager RN position is 100% remote; employee can live in any state. No travel expected.

Monday-Friday, 8:00am - 4:30pm with a 10:30am-7:00pm rotation several times per quarter in the time zone of residence. Rotational coverage of evenings, weekends, and holidays as needed.

The Case Manager RN utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. The process includes assessing the member’s health status and care coordination needs, inpatient review, discharge planning, developing and implementing the case management plan, monitoring and evaluating, and involving the Medical Director as indicated and closing the case when appropriate.

• Apply data-driven methods to identify members for individualized case management programs or referrals to alternative healthcare programs.
• Conduct comprehensive clinical assessments.
• Evaluate needs and develop flexible approaches based on member needs, benefit plans, or external programs/services.
• Advocate for patients to the full extent of existing health care coverage.
• Promote quality, cost-effective outcomes and suggest improvements to program/operational efficiency.
• Identify and elevate quality-of-care issues through established channels.
• Provide a high level of customer service.
• Use assessment techniques to determine member’s health literacy, technology capabilities, and readiness to change.
• Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimal health.
• Provide coaching, information, education, and support to empower members to make ongoing independent medical or healthy lifestyle choices.

• Active and unrestricted RN license in state of residence and willingness to obtain multi-state licensure upon hire (expenses paid by company).
• 3+ years of acute care experience as an RN.
• 3+ years of experience with Microsoft Office suite of products.

• Compact RN License.
• Certified Case Manager (CCM).
• Case Management experience.
• Managed Care experience.
• Telephonic case management and/or telephonic customer service center experience.
• 2+ years of Oncology Care experience.

• Minimum Associate Degree in Nursing required.
• BSN preferred.

The typical pay range for this role is $54,095.00 - $. The actual base salary will depend on experience, education, geography and other factors. The position is eligible for CVS Health bonus, commission or short-term incentive program in addition to the base pay range.

This full-time position is eligible for a comprehensive benefits package including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources based on eligibility.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.