Case Manager Registered Nurse

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.

Location:
Work at Home New York

Schedule:
Mon-Fri 08:00-05:00 PM EST

The Case Manager RN is responsible for providing comprehensive care management services to members with complex medical, behavioral health, and social needs. The role includes conducting clinical assessments, developing and monitoring person-centered care plans, coordinating care across providers and community resources, facilitating transitions of care, identifying and addressing barriers to health outcomes, and ensuring members receive medically necessary and cost-effective services.

The Case Manager RN collaborates with interdisciplinary teams, members, caregivers, and providers to promote quality outcomes, member satisfaction, regulatory compliance, and achievement of organizational goals.

• Active and unrestricted Registered Nurse (RN) license in the applicable state.
• Minimum of 3 to 5 years of clinical nursing experience, preferably in care management, case management, home care, long-term care, managed care, utilization management, or community-based healthcare settings.
• Experience coordinating care for members with complex medical, behavioral health, and psychosocial needs.
• Strong knowledge of chronic disease management, care coordination, and healthcare delivery systems.
• Ability to perform clinical assessments, identify member needs, and develop comprehensive care plans.
• Excellent communication, organizational, critical thinking, and problem-solving skills.
• Proficiency in Microsoft Office applications and electronic documentation systems.
• Ability to work independently while effectively collaborating with interdisciplinary teams.

• Certified Case Manager (CCM) certification or willingness to obtain certification.
• Experience working in Managed Long-Term Care (MLTC), Medicare, Medicaid, Dual Eligible, or other managed care populations.
• Knowledge and experience with the Uniform Assessment System (UAS-NY) and person-centered service planning.
• Experience coordinating home and community-based services (HCBS), long-term services and supports (LTSS), and behavioral health services.
• Bilingual skills preferred.
• Experience working in a remote or field-based care management environment

• Bachelor's Degree in Nursing (BSN) preferred.
• Current, unrestricted Registered Nurse (RN) license required.
• Additional certifications in Case Management, Care Coordination, Utilization Management, or related specialties are preferred.

• You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and
• A minimum download speed of 25 mbs download and 3 mbs upload. Wi‑Fi and satellite internet are not permitted.
• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS
• Health and HIPAA guidelines and allowing for uninterrupted work during work hours.
• Work‑from‑Home colleagues are required to work within the state and city where they have confirmed they currently live.
• The company will provide equipment (keyboard, monitor, computer, headset, etc.).
• All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your…