Remote Nurse Case Manager & Care Navigator

CVS Health Corporation; Annapolis (MD); Remote; USD 54,000 - 156,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an experienced Registered Nurse for a remote, work-from-home Case Manager role across the US. You will collaborate with patients, care teams and providers to apply clinical guidelines and coordinate utilization management for fully and self-insured clients.

The ideal candidate has 5+ years of RN experience (including hospital), a multistate license, and oncology exposure. This full-time position offers comprehensive benefits and a competitive salary range.

Qualifications

• 5+ years' experience as a Registered Nurse, including at least 1 year in a hospital setting.
• RN with active multistate license via NLC or state-specific license for each state supported.
• 1+ years' experience documenting electronically using a keyboard.
• 1+ years' current or previous experience in Oncology.

Responsibilities

• Work as a telephonic case manager with patients and care teams for fully and/or self-insured clients.
• Apply criteria, clinical guidelines, care plans, and regulatory standards while assessing benefits and member needs.
• Use clinical judgment to design strategies to reduce risk factors and address complex indicators in care planning.
• Assess information from multiple sources to address co-morbid conditions impacting functionality.
• Consult with supervisor and team to overcome barriers and present cases for multidisciplinary review.
• Collaborate with clinical colleagues to resolve barriers to goals and objectives.
• Follow case management processes in compliance with policies and procedures.
• Use motivational interviewing to maximize member engagement and assess health status.
• Identify and escalate member needs following set guidelines and protocols.
• Proactively reach out to members to guide their care.
• Perform medical necessity reviews.

Skills

RN License

Multistate licensure (NLC)

Electronic documentation

Oncology experience

Bilingual in Spanish

Education

Diploma or Associates Degree in Nursing

Job description

CVS Health is seeking an experienced Registered Nurse for a remote, work-from-home Case Manager role across the US. You will collaborate with patients, care teams and providers to apply clinical guidelines and coordinate utilization management for fully and self-insured clients.

The ideal candidate has 5+ years of RN experience (including hospital), a multistate license, and oncology exposure. This full-time position offers comprehensive benefits and a competitive salary range.