Remote RN Case Manager: Care Coordination

CVS Health; Columbus (OH); On-site; USD 61,000 - 130,000; Full time

Job summary

CVS Health is seeking a Community Care Case Manager to assess, plan, facilitate, and coordinate care for individuals and families, promoting quality, cost-effective outcomes through collaboration with providers, insurers, and community resources.

The role involves working with multidisciplinary teams, evaluating needs, and advocating for appropriate services while ensuring compliance with regulatory requirements and insurance guidelines.

Qualifications

• Active RN licensure in OH or state of residence.
• 3+ years clinical practical experience with Medicare members (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac).
• 2+ years case management, discharge planning and/or home health care coordination experience.

Responsibilities

• Acts as liaison with member/family, employer, providers, and insurance carriers.
• Coordinates case management for catastrophic and chronically ill members across the continuum of care.
• Interacts with members telephonically or in person, possibly at home, worksite, or physician's office.
• Assesses medical/vocational status; develops a care plan to optimize outcomes and return to baseline.
• Communicates with stakeholders and documents case work activities.

Skills

RN Licensure

Communication skills

Independent work

Problem solving

Bilingual Spanish

Education

Associate's Degree or Nursing Diploma

Bachelor's Degree

Tools

MS Word

Excel

Outlook

PowerPoint

Google Workspace

EHR portal

Job description

CVS Health is seeking a Community Care Case Manager to assess, plan, facilitate, and coordinate care for individuals and families, promoting quality, cost-effective outcomes through collaboration with providers, insurers, and community resources.

The role involves working with multidisciplinary teams, evaluating needs, and advocating for appropriate services while ensuring compliance with regulatory requirements and insurance guidelines.