Case Manager RN

CVS Health; Tennessee; Remote; USD 54,000 - 117,000; Full time

Job summary

An established industry player is seeking a dedicated Registered Nurse to join their remote team. This role involves telephonic case management, where you'll collaborate with patients and their care teams to ensure quality care and effective administration of benefits. Your expertise in Oncology or Transplant will be crucial as you navigate complex health needs, applying clinical judgment and motivational interviewing skills to engage members effectively. Join a company that values innovation and compassion in healthcare, offering a comprehensive benefits package and a supportive work environment.

Benefits

Affordable medical plan options

401(k) plan with matching contributions

Employee stock purchase plan

Wellness screenings

Tobacco cessation programs

Weight management programs

Confidential counseling

Financial coaching

Flexible work schedules

Tuition assistance

Qualifications

• 5+ years as a Registered Nurse, with hospital experience.
• Experience in Oncology or Transplant care is essential.

Responsibilities

• Work as a telephonic case manager with patients and care teams.
• Utilize clinical judgment for care planning and member engagement.

Skills

Registered Nurse

Oncology

Transplant

Motivational Interviewing

Case Management

Education

Diploma or Associates Degree in Nursing

BSN

Tools

Electronic Documentation

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 8:30am - 5pm within 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.

- This position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients
- Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits
- Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues
- Assessments utilize information from various sources to address all conditions including co-mor‐bid and multiple diagnoses that impact functionality
- Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management
- Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives
- Utilizes case management processes in compliance with regulatory and company policies and procedures
- Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversations
- Identifies and escalates member’s needs appropriately following set guidelines and protocols
- Need to actively reach out to members to collaborate/guide their care
- Perform medical necessity reviews

Required Qualifications
- 5+ years’ experience as a Registered Nurse with at least 1 year of experience in a hospital setting
- A Registered Nurse that holds an active, unrestricted license in their state of residence, and willingness to receive a multi-state/compact privileges and can be licensed in all non-compact states
- 1+ years’ current or previous experience in Oncology or Transplant
- 1+ years’ experience documenting electronically using a keyboard

Preferred Qualifications
- 1+ years’ Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience as well as experience with transferring patients to lower levels of care
- 1+ years' experience in Utilization Review
- CCM and/or other URAC recognized accreditation preferred
- 1+ years’ experience with MCG, NCCN and/or Lexicomp
- Bilingual in Spanish preferred

Education
- Diploma or Associates Degree in Nursing required
- BSN preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,095.00 - $116,760.00

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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visithttps://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 05/13/2025

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