Case Manager - Registered Nurse

CVS Health; United States; Remote; USD 54,000 - 117,000; Full time

Job summary

A leading health solutions company is seeking a Community Care Case Manager to enhance health outcomes for members. The role involves assessment, care coordination, and collaboration with healthcare professionals to ensure quality care. Candidates should possess a nursing degree and relevant experience in case management. The position offers competitive pay and comprehensive benefits, including medical plans and a 401(k).

Benefits

Affordable medical plan options

401(k) plan with matching contributions

Employee stock purchase plan

Wellness screenings

Tobacco cessation programs

Weight management programs

Confidential counseling

Financial coaching

Tuition assistance

Flexible work schedules

Qualifications

• 3 years clinical practical experience with Medicare members.
• Registered Nurse with active state license required.
• Ability to occasionally travel for in-person case management activities.

Responsibilities

• Acts as a liaison with members, providers, and insurance companies.
• Implements and coordinates case management activities.
• Develops a plan of care to facilitate member's condition management.

Skills

Analytical Skills

Problem Solving

Communication

Organizational Skills

Interpersonal Skills

Education

Bachelors of Science in Nursing

Associates Degree in Nursing

Tools

MS Word

Excel

Outlook

PowerPoint

Job description

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.

Position Summary

Community CareCase Manager use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes.

Additional responsibilities to include but not limited to the following:

- Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.

- Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care.

- Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes,worksites, or physician’s office to provide ongoing case management services.

- Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate.

- Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person.

- Prepares all required documentation of case work activities as appropriate.

- Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes.

- May make outreach to treating physician or specialists concerning course of care and treatment as appropriate.

- Provides educational and prevention information for best medical outcomes.

- Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources.

- Testifies as required to substantiate any relevant case work or reports.

- Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data.

- Utilizes case management processes in compliance with regulatory and company policies and procedures.

- Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work.

- 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/client’s overall wellness through integration.

- Monitors member/client progress toward desired outcomes through assessment and evaluation.

Required Qualifications

- 3 years clinical practical experience: (Diabetes, CHF, CKD, Post-Acute Care, Hospice, Palliative Care, Cardiac) with Medicare members.

- Registered Nurse with active state license in good standingwithin the regionwhere job duties are performed is required.

- Ability to occasionally travel within a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs arise

Preferred Qualifications

- 2 years CM, Discharge Planning, and/or Home Healthcare coordination experiencepreferred

- Excellent analytical andproblem-solvingskills

- Effective communications, organizational, and interpersonal skills.

- Ability to work independently (may require working from home).

- Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.

- Efficient and Effective computer skills including navigating multiple systems and keyboarding

- Compact RN licensure

- Certified Case Manager

- Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM)

- Bachelors of Science in Nursing

Education

Associates Degree in Nursing

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,095.00 - $116,760.00

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.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

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.

• 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.

For more information, visithttps://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 05/30/2025

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