Enable job alerts via email!

Case Manager Registered Nurse- Hybrid

The Muse

Charleston (WV)

Hybrid

USD 54,000 - 117,000

Full time

4 days ago
Be an early applicant

Boost your interview chances

Create a job specific, tailored resume for higher success rate.

Job summary

A leading health solutions company is seeking a Case Manager Registered Nurse for a hybrid role, responsible for directing care management and coordination for members. This position requires clinical judgment, experience with Medicaid, and a commitment to fostering member health through tailored care strategies. The role offers comprehensive pay and benefits, promoting wellness for employees and their families.

Benefits

Affordable medical plan options
401(k) plan with matching contributions
Employee stock purchase plan
Wellness screenings and counseling programs
Flexible work schedules and dependent care resources

Qualifications

  • Minimum 3+ years clinical experience, preferably with Medicaid members.
  • Experience in case management and home health care coordination.
  • Registered Nurse license in good standing required.

Responsibilities

  • Conduct assessments and develop care plans for members.
  • Provide crisis intervention and ensure members receive appropriate treatment.
  • Analyze clinical data to identify comprehensive member needs.

Skills

Clinical judgment
Care coordination
Crisis intervention
Motivational interviewing

Education

RN with current unrestricted WV state licensure

Job description

Join to apply for the Case Manager Registered Nurse- Hybrid role at The Muse

2 days ago Be among the first 25 applicants

Join to apply for the Case Manager Registered Nurse- Hybrid role at The Muse

Get AI-powered advice on this job and more exclusive features.

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

Brief Overview

This is a Hybrid role. The Care Manager RN will be responsible to work from home as well as visit members homes.The Care Manager RN is r esponsible for driving and supporting care management and care coordination activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating) . The CM RN u tilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wrap around services to promote effective utilization of available resources and optimal , cost-effective outcomes.

What You Will Do

  • R esponsible for telephonic and/or face to face assess ment, planning, implementing and coordinating ca r e management activities with members to ensure that the ir medical and behavioral health needs are met and to enhance the member's overall wellness.
  • Develops a proactive course of action to address issues presented and facilitate short and long-term outcomes as well as identify opportunities to enhance a member's overall health through integration.
  • Through the use of clinical tools and information/data review, conducts comprehensive assessments of member's needs and recommends an approach to case resolution by m eeting needs in alignment with their benefit plan and available internal and external programs and services.
  • Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address es complex health and social indicators which impact care planning and resolution of member issues.
  • Completes assessments that take i nto account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality and the member's restrictions and limitations.
  • Analyzes utilization , self- report and clinical data available to consolidate information and begin to identify comprehensive member needs.
  • Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated .
  • Provides crisis follow up to members to help ensure they are receiving the appropriate treatment and services.
  • Appli es and/or interprets applicable criteria and clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards while assessing benefits and member's needs to ensure appropriate administration of benefits.
  • Serves as a single point of contact for members and assists members to remediate immediate and acute gaps in care and access.
  • Using a holistic approach consults with manager , medical d irectors , and/or other physical/behavioral health support staff and providers to overcome barriers to meeting goals and objectives .
  • P resents cases at case conferences /rounds to obtain multidisciplinary view in order to achieve optimal outcomes.
  • Works collaboratively with the members' interdisciplinary care team.
  • Identifies and escalates quality of care issues through established channels.
  • Ability to speak to medical and behavioral health professionals to influence appropriate member care.
  • Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
  • Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
  • Helps member actively and knowledgably participate with their provider in healthcare decision-making.
  • In collaboration with the member and their care team develops and monitors established plans of care to meet the member's goals.
  • Utilizes care management processes in compliance with regulatory and company policies and procedures.
  • Facilitates clinical hand offs during transitions of care.

Required Qualifications

  • Minimum 3+ years clinical practical experience preference: with Medicaid members.
  • Minimum 2+ years CM, discharge planning and/or home health care coordination experience
  • Registered Nurse with active unrestricted state license in good standing within the region where job duties are performed is required.
  • Staff must be able to travel to meet members within the southern region of the state in the counties listed below.

Boone

Pocahontas

Greenbrier

Raleigh

Logan

Summers

McDowell

Wyoming

Mercer

Mingo

MonroePreferred Qualifications

  • BSN preferred
  • Preferred working with high-risk OB and high risk newborns
  • Case management in an integrated model preferred
  • Managed care experience preferred
  • D ischarge planning experience preferred
  • Experience providing care to the Medicaid population preferred

Education

RN with current unrestricted WV state licensure required Anticipated Weekly Hours

40Time Type

Full timePay Range

The typical pay range for this role is:$54,095.00 - $116,760.00This 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 peopleWe 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, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 06/13/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Seniority level
  • Seniority level
    Mid-Senior level
Employment type
  • Employment type
    Full-time
Job function
  • Job function
    Health Care Provider
  • Industries
    Technology, Information and Internet

Referrals increase your chances of interviewing at The Muse by 2x

Sign in to set job alerts for “Case Management Nurse” roles.
Registered Nurse (RN) - Assisted Living/Skilled Nursing- Pick Your Own Schedule
Travel ICU Registered Nurse (Critical Care) - $2,186 per week

South Charleston, WV $2,185.00-$2,185.00 1 week ago

Travel Registered Nurse Long Term Acute Care

Charleston, WV $1,724.00-$1,724.00 5 days ago

Travel Registered Nurse Med Surg / Telemetry

South Charleston, WV $2,079.56-$2,079.56 1 week ago

Travel Registered Nurse Med Surg / Telemetry

South Charleston, WV $2,079.56-$2,079.56 1 week ago

Travel Registered Nurse Med Surg / Telemetry

South Charleston, WV $2,079.56-$2,079.56 1 week ago

Charleston, WV $1,751.22-$1,751.22 4 hours ago

Charleston, WV $1,634.47-$1,634.47 4 months ago

South Charleston, WV $2,171.02-$2,171.02 1 week ago

Charleston, WV $54,095.00-$116,760.00 1 week ago

Case Manager, Registered Nurse (West Virginia)

Charleston, WV $54,095.00-$116,760.00 1 day ago

Registered Nurse - RN / Intensive Care Unit - ICU

South Charleston, WV $2,477.79-$2,477.79 1 week ago

Corrections Case Manager - DCR/Harrison County Youth Reporting Center - Harrison Co.
Registered Nurse - RN / Intensive Care Unit - ICU
Travel Registered Nurse Long Term Acute Care

Charleston, WV $1,783.28-$1,783.28 3 days ago

Charleston, WV $1,751.22-$1,751.22 1 month ago

Charleston, WV $54,095.00-$116,760.00 4 hours ago

Travel Pulmonary Telemetry Registered Nurse - $1,977 per week

South Charleston, WV $1,976.00-$1,976.00 1 week ago

Travel Pulmonary Telemetry Registered Nurse - $2,162 per week

South Charleston, WV $2,161.00-$2,161.00 1 week ago

Travel Registered Nurse Long Term Acute Care

Charleston, WV $1,724.00-$1,724.00 5 days ago

Corrections Case Manager - DHS - DCR - Mount Olive Correctional Facility - See Posting
Registered Nurse - F1/OPT Visa Sponsorship

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.

Get your free, confidential resume review.
or drag and drop a PDF, DOC, DOCX, ODT, or PAGES file up to 5MB.

Similar jobs

Telephonic Nurse Case Manager I in Georgia

Elevance Health

Georgia

Remote

USD 60,000 - 100,000

3 days ago
Be an early applicant

Telephonic Nurse Case Manager I, GA

Elevance Health

Georgia

Remote

USD 60,000 - 100,000

3 days ago
Be an early applicant

Pediatric Care Manager (RN)

Sunshine Health

Tampa

Remote

USD 55,000 - 99,000

3 days ago
Be an early applicant

Care Manager - LCSW, LMFT, LMSW, LPCC or RN, or CEAP

The Judge Group

California

Remote

USD 80,000 - 100,000

4 days ago
Be an early applicant

Manager Nurse Practitioner, 100% Virtual, CareBridge

Santa Barbara Cottage Hospital

Virginia

Remote

USD 90,000 - 120,000

6 days ago
Be an early applicant

Care Manager Transition of Care - RN

Centene Corporation

Maine

Remote

USD 55,000 - 99,000

5 days ago
Be an early applicant

Quality Compliance Nurse (Maternal-Child Health/EPSDT)

Humana

Virginia

Remote

USD 71,000 - 98,000

3 days ago
Be an early applicant

RN Transplant Case Mgr II in Columbus, Ohio

Elevance Health

Ohio

Remote

USD 72,000 - 156,000

3 days ago
Be an early applicant

Transitions of Care RN, Multiple Locations

Elevance Health

Kansas

Remote

USD 54,000 - 117,000

3 days ago
Be an early applicant