Remote RN Case Manager: Care Coordination Expert

CVS Health; Fulton (MS); Remote; USD 61,000 - 130,000; Full time

Job summary

CVS Health is seeking an experienced Case Manager - Registered Nurse (RN) for a fully remote position under the National Medical Excellence team. The role blends Case Management and Utilization Management, assessing and coordinating care for members to support wellness.

You will use clinical judgment and data to evaluate needs, eligibility, and transitions to CVS programs, while collaborating with supervisors and other care teams.

Qualifications

• Active, current and unrestricted compact RN licensure in the state of residence.
• 5 years clinical practice as an RN.
• 2+ years in critical care.
• 6+ months in case management or utilization management.
• Ability to work Monday–Friday 8 AM–5 PM in the time zone of residence.
• Must be able to obtain multi-state RN licensures.

Responsibilities

• Assess, plan, implement and coordinate case management activities with members.
• Evaluate medical needs and facilitate overall wellness.
• Review prior claims to assess impact on case management and eligibility.
• Present cases at case conferences for multidisciplinary focus.
• Ensure compliance with regulatory and company policies.

Skills

Compact RN licensure

Clinical practice experience

Critical care

Case management experience

Work schedule 8am-5pm

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Compact RN licensure in resident state

Tools

Microsoft Office 365

Job description

CVS Health is seeking an experienced Case Manager - Registered Nurse (RN) for a fully remote position under the National Medical Excellence team. The role blends Case Management and Utilization Management, assessing and coordinating care for members to support wellness.

You will use clinical judgment and data to evaluate needs, eligibility, and transitions to CVS programs, while collaborating with supervisors and other care teams.