Case Manager, Registered Nurse (Remote, Massachusetts)

CVS Health; Oklahoma City (OK); Remote; USD 52,000 - 68,000; Full time

Job summary

CVS Health in Oklahoma City is seeking a Case Manager to coordinate comprehensive care for members, assess needs, and develop personalized care plans. You will work with providers, insurers, and community resources to address health and social determinants.

The role emphasizes advocacy, progression monitoring, and ensuring appropriate service utilization across the continuum of care to promote well-being and timely return to baseline.

Qualifications

• Experience coordinating case management in healthcare settings.
• Strong communication with members, providers, and insurers.
• Ability to assess needs and develop personalized care plans.

Responsibilities

• Acts as liaison with member/family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.
• Coordinates case management activities for catastrophic cases and chronically ill members across the continuum of care.
• Interacts with members telephonically or in person.
• May meet with members in their homes or workplaces to provide ongoing case management services.
• Assesses and analyzes medical and vocational status; develops a plan of care to facilitate wellness and medical outcomes.
• Communicates with member and other stakeholders (providers, attorneys, employers, insurers) telephonically or in person.
• Prepares all required documentation of case work activities.
• Interacts with internal multidisciplinary team to optimize health outcomes.

Skills

Case management

Communication

Healthcare coordination

Job description

Position Summary

Help us elevate our patient care to a whole new level! Join our team as an industry leader in serving our members by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members. Community Care is a member centric, team-delivered, community-based care management model that joins members where they are. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country.

As a case manager, you will coordinate and facilitate comprehensive care for individuals by assessing their needs, developing personalized care plans, and coordinating services across healthcare providers. Serves as advocate for patients, ensuring effective communication, resource utilization, and continuous monitoring of their progress to promote positive outcomes and enhance overall well-being.

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.
• 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,