Case Manager Registered Nurse - RN

The Muse; Sacramento (CA); Remote; USD 54,000 - 143,000; Full time

Job summary

A leading healthcare company is seeking a Case Manager Registered Nurse to join their high-risk maternity case management team. This fully remote position requires a compact RN license and 3+ years of clinical experience. Responsibilities include managing members' maternity journeys and ensuring compliance with regulatory policies. Attractive benefits include flexible schedules and a comprehensive wellness program.

Benefits

Medical Benefits

401(k)

Stock Purchase Plans

Paid Time Off

Flexible Schedules

Qualifications

• Active RN license required.
• 3+ years experience in women's health, infertility, maternity, or OB-GYN settings.

Responsibilities

• Assess and manage member's maternity journey.
• Use clinical tools to evaluate member needs.
• Collaborate with multidisciplinary teams.

Skills

Clinical Judgment

Care Coordination

Assessment

Communication

Education

Associates Degree

BSN (Preferred)

Tools

Microsoft Office

Job description

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

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. We do it all with heart, each and every day.

Position Summary

This is a 100% remote work-from-home position, open to candidates from any state with a compact RN license. The hours are Monday - Friday, 8:00 am - 4:30 pm in your time zone, with a one-week rotation from 12:30 pm to 9:00 pm EST every 3-4 months. This role is for a Fertility Advocate in a high-risk maternity case management team, and experience in this area is required.

The Case Manager RN assesses, plans, implements, and coordinates all case management activities with members to evaluate their medical needs and facilitate their overall wellness within a high-risk maternity program. The RN manages all aspects of a member's maternity journey, developing proactive strategies to improve short- and long-term outcomes and overall wellness.

The responsibilities include:

• Using clinical tools and data review to evaluate member needs, benefit plan eligibility, and facilitate smooth transitions to Aetna programs.
• Applying clinical judgment to reduce risk factors and address complex health and social indicators impacting care.
• Considering information from various sources to address all conditions, including co-morbidities and multiple diagnoses.
• Reviewing prior claims to assess their impact on current case management and eligibility.
• Assessing the member's work capacity and restrictions.
• Recommending referrals to clinical resources as needed.
• Collaborating with supervisors and multidisciplinary teams to overcome barriers and benefit overall case management.
• Ensuring compliance with regulatory and company policies.
• Engaging members through effective interviewing to discern health needs.

Qualifications

• Active, current, and unrestricted RN license in the state of residence.
• Willingness to pursue multi-state licensure (paid for by the company).
• Minimum of 3+ years of clinical experience in women's health, infertility, maternity, or OB-GYN settings.

Preferred Skills

• RN licensure in a compact state.
• 1+ years of case management experience in an integrated model.
• Experience with telephonic case management.
• Proficiency in Microsoft Office applications.
• Certified Case Manager (CCM) certification.
• Experience with ATV/ASD.

Education

Associates Degree required; BSN preferred.

Work Details

• Estimated weekly hours: 40
• Full-time employment
• Pay range: $54,095 - $142,576 annually, depending on experience and location.

Benefits include medical, 401(k), stock purchase plans, wellness programs, paid time off, flexible schedules, and more. For details, visit CVS Health Benefits.

The application deadline is 06/06/2025. Qualified applicants with arrest or conviction records will be considered in accordance with laws.

Additional Information

• Seniority level: Mid-Senior level
• Employment type: Full-time
• Job function: Healthcare Provider