Case Manager RN- High Point, NC

CVS Health; Raleigh (NC); À distance; USD 54 000 - 117 000; Plein temps

Avantages offerts par ce poste

Medical benefits

Dental benefits

Vision benefits

Paid time off

Retirement savings options

Résumé du poste

CVS Health is seeking a Case Manager RN based in North Carolina for a telework role. The position requires an active NC RN license, 2+ years of clinical RN experience, and the ability to obtain multistate licensure if needed. The role emphasizes coordinating care, assessing needs, and facilitating program transitions.

Typical hours are Monday–Friday, with some evenings/holidays as needed. A comprehensive benefits package and opportunities for growth are provided.

Qualifications

• Must live in North Carolina and hold an active RN license.
• Minimum 2+ years of RN clinical experience.
• Willingness to obtain multi-state RN licensure if needed.

Responsabilités

• Telephone-based assessment and coordination of case management for members.
• Develop proactive action plans to improve outcomes and wellness.
• Review claims and benefit eligibility; facilitate transitions to CVS/Aetna programs.
• Apply clinical judgment to reduce risk and barriers in care planning.
• Assess member conditions, comorbidities, and work capacity.
• Refer to clinical resources for functional support as needed.
• Consult with supervisors; present cases at conferences for multidisciplinary input.
• Ensure compliance with regulatory and CVS Health policies.
• Engage members to maximize engagement via interviews and questions.

Connaissances

RN licensure NC

Case management experience

Microsoft Office

CCM certification

Telework/Remote work

Formation

Associates Degree in Nursing

Outils

Microsoft Office 365

Description du poste

Company Culture / About Us

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

The Case Manager RN role is telework and must be located in North Carolina.

Working Hours

Monday through Friday 9:00am – 5:30pm EST. Occasional evening, and holiday shifts per the needs of the team.

Travel

0-10% travel possible including but not limited to travel to the High Point office for customer meetings if you reside within 30 miles.

Responsibilities

• The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.
• 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 overall wellness through integration.
• Through the use of clinical tools and information/data review, conducts an evaluation of member’s needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
• 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 take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
• Reviews prior claims to address potential impact on current case management and eligibility.
• Assessments include the member’s level of work capacity and related restrictions/limitations.
• Using a holistic approach assess the need for a referral to clinical resources for assistance in determining 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.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Required Qualifications

• Must live in North Carolina
• Must have an active and unrestricted RN license in the state of North Carolina.
• Multiple State RN licensure is welcomed but not required. If chosen must be willing and able to obtain multiple state RN licensure after hire (expenses paid for by company)
• 2+ years of clinical experience as an RN
• All clinical experience will be considered, such as Emergency Department, Home Health, Hospice, Operating Room, ICU, NICU, Telemetry, Medical / Surgical, Orthopedics, Long Term Care, and Infusion nursing.

Preferred Qualifications

• Certified Case Manager (CCM) certification
• 3+ years’ experience with Microsoft Office Suite
• Case Management in an integrated model
• Discharge Planning experience
• Managed care experience
• BSN

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 including working with AI tools and products as needed by the company.

Education

Associates Degree in Nursing

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.

Benefits

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.

Application Window

We anticipate the application window for this opening will close on: 10/26/2026

EEO / Diversity Statement

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