Case Manager - Registered Nurse - South Region

CVS Health; United States; A distancia; USD 61.000 - 130.000; Jornada completa

Descripción de la vacante

CVS Health is seeking a Community Care Case Manager to coordinate complex health needs for members and families in the South region. You will collaborate with providers, insurers, and care teams to assess, plan, implement, and evaluate case management services across settings, aiming for quality outcomes and cost efficiency.

Ideal candidates hold an RN license, have 3+ years of clinical experience and 2+ years in case management, and are proficient with MS Office and EHRs. Remote work possible.

Formación

• Active and unrestricted Compact RN licensure in OH or state of residence.
• 3+ years clinical practical experience with Medicare members.
• 2+ years case management, discharge planning, or home health care coordination.
• Reside in CVS Health South Region or willing to relocate.
• Bilingual Spanish preferred.

Responsabilidades

• Serve as liaison with member/family, employer, providers, and insurers.
• Coordinate case management activities for catastrophic and chronically ill members across the continuum of care.
• Interact with members telephonically or in person; may meet at home, worksites, or physician offices.
• Assess medical and vocational status; develop a care plan to optimize wellness and outcomes.
• Communicate with stakeholders; document case work and outcomes.
• Consult with internal multidisciplinary team to maximize health outcomes.
• Provide educational and prevention information.
• Comply with laws and regulations for rehabilitation services; testify when required.
• Evaluate needs and determine benefit plan eligibility.

Conocimientos

Spanish

Analytical skills

Problem-solving

Communication skills

Organizational skills

Interpersonal skills

Educación

Associate's Degree or Nursing Diploma

Bachelor's Degree (preferred)

RN licensure (Compact state)

Herramientas

MS Office 365

EHR systems

Descripción del empleo

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

Community CareCase Manager use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes.

• 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.
• Testifies as required to substantiate any relevant case work or reports.
• 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, as well as opportunities to enhance a member’s/client’s overall wellness through integration.
• Monitors member/client progress toward desired outcomes through assessment and evaluation.

Required Qualifications

• Candidate must reside in the South Region: OH, VA, NC, KY, TN, SC, GA, AL, MS, AR, LA, FL
• Candidate must have active and unrestricted Compact Registered Nurse (RN) Licensure in OH or in their state of residence
• 3+ years clinical practical experience preference: (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members
• 2+ years case management, discharge planning and/or home health care coordination experience

Preferred Qualifications

• Bilingual - Spanish
• Excellent analytical andproblem-solvingskills
• Effective communications, organizational, and interpersonal skills.
• Ability to work independently (may require working from home)
• Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications
• Efficient and effective computer skills including navigating multiple systems and keyboarding
• Willing and able to obtain multi state Registered Nurse (RN) licenses if needed, company will provide
• Certified Case Manager
• National professional certification (CRC, CDMS, CRRN, COHN, or CCM)

Education

• Associate's Degree or Nursing Diploma (REQUIRED)
• Bachelor's Degree (PREFERRED)

License

• Active and unrestricted Compact Registered Nurse (RN) Licensure in OH or in their state of residence

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 mbs download and 3 mbs 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: 10/27/2026

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