Case Manager, Registered Nurse - Oncology

Hispanic Alliance for Career Enhancement; Montpelier (VT); Remote; USD 54,000 - 143,000; Full time

Job summary

A leading health solutions company is seeking a telephonic case manager to work remotely. The role involves managing patient care, conducting assessments, and collaborating with care teams. Applicants must be Registered Nurses with significant experience, including oncology. Comprehensive benefits and a competitive salary range are offered.

Benefits

Medical plans

401(k) with matching

Stock purchase plans

Flexible work schedules

Tuition assistance

Qualifications

• 5+ years of experience as a Registered Nurse (RN), including at least 1 year in a hospital setting.
• Active, unrestricted RN license in the state of residence.

Responsibilities

• Work as a telephonic case manager with patients and their care team.
• Conduct assessments using information from various sources.
• Utilize motivational interviewing skills to maximize member engagement.

Skills

Communication

Clinical Judgment

Motivational Interviewing

Education

Diploma or Associate's Degree in Nursing

BSN

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

This is a remote work-from-home role anywhere in the US with virtual training. Shift schedule is 8:30 am - 5:00 pm within the time zone of residence.

American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management, and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members.

Key Responsibilities

• Work as a telephonic case manager with patients and their care team for fully and/or self-insured clients.
• Apply and interpret applicable criteria, clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards while assessing benefits and member needs to ensure appropriate benefits administration.
• Use clinical judgment to incorporate strategies to reduce risk factors and barriers, addressing complex health and social indicators impacting care planning and member issues.
• Conduct assessments using information from various sources to address all conditions, including co-morbid and multiple diagnoses affecting functionality.
• Consult with supervisors and colleagues to overcome barriers, present cases at case conferences for multidisciplinary focus, and benefit overall claim management.
• Adopt a holistic approach by consulting with clinical colleagues, supervisors, Medical Directors, and other programs to overcome barriers to meeting goals.
• Follow case management processes in compliance with regulatory and company policies.
• Utilize motivational interviewing skills to maximize member engagement and discern their health status and needs.
• Identify and escalate member needs appropriately following set guidelines and protocols.
• Actively reach out to members to collaborate and guide their care.
• Perform medical necessity reviews.

Required Qualifications

• 5+ years of experience as a Registered Nurse (RN), including at least 1 year in a hospital setting.
• Active, unrestricted RN license in the state of residence, with willingness to obtain multi-state/compact privileges and licensure in non-compact states.
• 1+ years of experience documenting electronically.
• 1+ years' experience in Oncology.

Preferred Qualifications

• 1+ years' experience in Case Management, discharge planning, nurse navigation, or nurse care coordination, including transferring patients to lower levels of care.
• 1+ years' experience in Utilization Review.
• CCM and/or other URAC accreditation preferred.
• Experience with MCG, NCCN, and/or Lexicomp.
• Bilingual in Spanish preferred.

Education

• Diploma or Associate's Degree in Nursing required.
• BSN preferred.

Additional Details

Anticipated weekly hours: 40

Time type: Full-time

Pay Range

The typical pay range is $54,095.00 - $142,576.00. Actual offers depend on experience, education, location, and other factors. This role is eligible for bonuses, commissions, or incentives.

Benefits

We offer comprehensive benefits, including:

• Medical plans, 401(k) with matching, and stock purchase plans.
• No-cost wellness programs, counseling, and financial coaching.
• Flexible work schedules, paid time off, family leave, dependent care resources, tuition assistance, retiree medical access, and more.

For more info, visit https://jobs.cvshealth.com/us/en/benefits

Application deadline: 05/28/2025

Qualified applicants with arrest or conviction records will be considered according to law.