Remote RN Case Manager: Care Coordination Lead

CVS Health; Connecticut; Hybrid; USD 54,000 - 143,000; Full time

Job summary

CVS Health is seeking a licensed RN Case Manager to coordinate comprehensive care for members and develop personalized care plans in a team-driven, community-based model. You will liaise with members, providers, and insurers to coordinate services, monitor progress, and advocate for timely access to benefits while maintaining HIPAA compliance and quality standards.

The role supports work-from-home in the U.S.

Qualifications

• Active RN license in resident state (PA, OH, FL, NJ, GA, NC, TX, CT).
• 3+ years of clinical experience (diabetes, CHF, CKD, post-acute, hospice, palliative, cardiac, Home Health) with Medicare.
• 2+ years of case management, discharge planning, or home health coordination.
• Proficiency with Word, Excel, Outlook, PowerPoint; familiarity with proprietary applications.

Responsibilities

• Acts as a liaison with member/client/family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.
• Implements and coordinates all case management activities for catastrophic and chronically ill members across the continuum of care.
• Interacts with members telephonically or in person; may visit homes, worksites, or physician offices.
• Assesses medical/vocational status; develops a plan of care to optimize wellness and medical outcomes.
• Communicates with stakeholders telephonically or in person (providers, attorneys, employers, insurers).
• Prepares documentation of case work activities; coordinates with multidisciplinary team.
• Outreach to treating physicians or specialists as appropriate.
• Provides educational and prevention information for best medical outcomes.
• Applies laws and regulations for rehabilitation services; adheres to insurer and referral instructions.
• Evaluates member needs and eligibility; uses clinical tools and data.
• Utilizes case management processes in compliance with policies.
• Facilitates return to baseline and best functional outcomes.
• Develops proactive actions to improve short/long-term outcomes.
• Monitors progress toward outcomes through assessment.

Skills

RN licensure

Case management

Communication

Time management

Computer skills

Bilingual - Spanish

Education

ASN

BSN

Tools

Microsoft Word

Excel

Outlook

PowerPoint

Job description

CVS Health is seeking a licensed RN Case Manager to coordinate comprehensive care for members and develop personalized care plans in a team-driven, community-based model. You will liaise with members, providers, and insurers to coordinate services, monitor progress, and advocate for timely access to benefits while maintaining HIPAA compliance and quality standards.

The role supports work-from-home in the U.S.