Remote RN Case Manager: Care Coordination & Wellness

CVS Health; Montgomery (AL); Remote; USD 61,000 - 130,000; Full time

Job summary

CVS Health’s National Medical Excellence (NME) team is hiring a Case Manager - Registered Nurse (RN). This fully remote role welcomes candidates nationwide, with preference for those in compact RN states.

The RN Case Manager conducts telephonic and in-person assessments, plans and coordinates care, and supports members to meet their wellness goals. You will apply clinical judgment to reduce risk, review eligibility and benefits, and collaborate with a multidisciplinary team.

Qualifications

• Active, current compact RN licensure in resident state.
• 5 years of RN clinical practice.
• 2+ years in critical care.
• 6+ months in case management or utilization management.

Responsibilities

• Develop proactive action to enhance member outcomes and wellness.
• Evaluate member needs and eligibility for benefits via data review.
• Apply clinical judgment to reduce risk factors and barriers.
• Assess co-morbidity and diagnoses affecting functionality.
• Review prior claims for impact on case management and eligibility.
• Coordinate referrals to clinical resources as needed.
• Participate in case conferences for multidisciplinary review.
• Ensure compliance with regulatory and company policies in CM processes.
• Engage members via interviewing to assess health status and needs.

Skills

RN licensure

Clinical nursing

Critical care

Case management experience

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Tools

Microsoft Office 365

EHR systems

Job description

CVS Health’s National Medical Excellence (NME) team is hiring a Case Manager - Registered Nurse (RN). This fully remote role welcomes candidates nationwide, with preference for those in compact RN states.

The RN Case Manager conducts telephonic and in-person assessments, plans and coordinates care, and supports members to meet their wellness goals. You will apply clinical judgment to reduce risk, review eligibility and benefits, and collaborate with a multidisciplinary team.