Case Manager RN - Registered Nurse

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

This RN Case Manager role is 100% remote and the employee can live in any state and telework, however, there is a preference for an RN in a Compact RN state.

Normal hours are Monday through Friday 8:00am – 4:30pm in the time zone of residence with occasional late shift rotation until 8:00pm EST.

There are no weekends or holiday shifts required at this time.

Travel of less than 5% may be required in the event of clinical audits.

• 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, conducts an evaluation of member’s needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
• Assessments take into account information from various sources to address all conditions including co‑morbid and multiple diagnoses that impact functionality.
• Reviews prior claims to address potential impact on current case management and eligibility.
• Assessments include the member’s level of work capacity and related restrictions/limitations.
• Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.
• Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
• 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.

• Must have an active and unrestricted RN license
• Willingness and ability to obtain additional state licenses upon hire (paid for by the company)
• 3+ years of acute hospital clinical experience as an RN (general medical, post‑surgical, ICU experience).

• 1+ years of case management experience
• Compact RN licensure
• Certified Case Manager (CCM) certification
• Experience with all types of Microsoft Office including PowerPoint, Excel, and Word
• Strong telephonic communication skills

• Associate’s degree in nursing is minimum required. BSN preferred.

40

Full time

The typical pay range for this role is:

$54,095.00 - $

This pay range represents the base hourly rate or base annual full‑time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short‑term incentive program in addition to the base pay range listed above.

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan
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• No‑cost programs for all colleagues including wellness screenings,…