Case Manager, Registered Nurse (Remote)

CVS Health; Ohio; Hybrid; USD 61,000 - 130,000; Full time

Benefits offered by this job

Comprehensive benefits package

Bonus eligibility

Remote work

Job summary

CVS Health is seeking a Case Manager RN to work 100% remotely. You will assess, plan, and coordinate care to meet members' health needs while ensuring cost-effective outcomes. The role requires strong clinical judgment, exceptional communication, and collaboration with diverse care teams.

The position offers flexible hours, with standard weekdays and rotational after-hours coverage, and requires an active RN license plus 3+ years of acute care experience. A BSN is preferred.

Qualifications

• Active and unrestricted RN license in state of residence and eligible for multi-state licensure.
• 3+ years of acute care RN experience.
• 3+ years with Microsoft Office Suite.
• Strong problem-solving and clinical decision-making skills.
• Ability to manage sensitive information professionally and confidentially.
• Excellent communication and relationship-building skills.
• Ability to work effectively with diverse patient populations and healthcare teams.

Responsibilities

• Apply data driven methods to identify members and tailor case management programs.
• Conduct comprehensive clinical assessments.
• Evaluate needs and develop flexible approaches based on plans and external programs.
• Advocate for patients to maximize health coverage.
• Promote quality and cost-effective outcomes and suggest improvements.
• Identify and elevate quality of care issues through established channels.
• Provide a high level of customer service to members.
• Assess health literacy, technology capability, and readiness to change.
• Provide coaching and support to empower ongoing healthy choices.

Skills

RN license

Acute care RN

Microsoft Office

Communication skills

Confidentiality

Education

Associate Degree in Nursing

BSN preferred

Job description

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.

Position Summary

This Case Manager RN position is 100% remote, and the employee can live in any state. No travel is expected with this position.

Normal Working Hours: Monday- Friday between 8:00am - 5:00pm in time zone of residence with rotational coverage of evenings, weekends, and holidays per the needs of the department.

The Case Manager RN utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.

The Case Manager RN process includes assessing the member's health status and care coordination needs, inpatient review, and discharge planning, developing, and implementing the case management plan, monitoring, and evaluating the plan and involving the Medical Director as indicated and closing the case as appropriate when the member has met discharge criteria.

The Case Manager RN role requires a nurse that can exercise independent and sound judgment and someone that has strong decision-making skills and well-developed interpersonal skills. The Case Manager RN is expected to manage multiple priorities, demonstrate both effective organizational and time management skills as well demonstrate strong teamwork skills.

This job will require time in a queue-type setting.

The responsibilities of this Case Manager RN position are to:

• Apply data driven methods of identification of members to fashion individualized case management programs and/or referrals to alternative healthcare programs.
• Conduct comprehensive clinical assessments.
• Evaluate needs and develop flexible approaches based on member needs, benefit plans, or external programs/services.
• Advocate for patients to the full extent of existing health care coverage.
• Promote quality, cost effective outcomes, and make suggestions to improve program/operational efficiency.
• Identify and elevate quality of care issues through established channels.
• Provide an expected very high level of customer service.
• Utilize assessment techniques to determine member's level of health literacy, technology capabilities, and/or readiness to change.
• Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
• Provide coaching, information, education, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.

Required Qualifications

• Active and unrestricted RN license in their state of residence and have the ability to obtain multi-state licensure upon hire.
• 3+ years of acute care experience as an RN.
• 3+ years of experience with Microsoft Suite of products.
• Strong problem-solving and clinical decision-making skills.
• Ability to manage sensitive information with professionalism and confidentiality.
• Excellent communication and relationship-building skills.
• Ability to work effectively with diverse patient populations and healthcare teams.

Preferred Qualifications

• Compact RN License.
• Certified Case Manager (CCM).
• Case Management experience.
• Managed Care experience.
• Telephonic case management and/or telephonic customer service center experience.

Education:

• Minimum of Associate Degree in Nursing required. BSN preferred.

Work from Home Requirements:

• 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 Mbps download and 3 Mbps upload. WiFi 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 desk for extended periods of time).
• If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical and Logistical Requirements:

• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
• Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
• Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
• Future Growth: Openness to learning new skills in the future as the workplace environment evolves.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:
$60,522.00 - $129,615.00

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 10/30/2026

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