Remote RN Case Manager - Care Coordination & Wellness

CVS Health; Tallahassee (FL); Remote; USD 61,000 - 130,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a Case Manager - Registered Nurse (RN) for a fully remote role with our National Medical Excellence (NME) team. The role blends case management and utilization management to assess, plan, implement, and coordinate care for members to support overall wellness.

Candidates from any state are welcome; compact RN licensure is required with 5+ years RN experience and 2+ years in critical care preferred. Weekday hours and comprehensive benefits offered.

Qualifications

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

Responsibilities

• Develops a proactive course of action to address issues to enhance outcomes and wellness.
• Evaluates member needs and benefit plan eligibility and facilitates transitions to Aetna programs and plans.
• Applies clinical judgment to reduce risk factors and address barriers affecting care planning.
• Assesses conditions including co-morb and multiple diagnoses impacting functionality.
• Reviews prior claims to assess impact on case management and eligibility.
• Assesses member work capacity and related restrictions/limitations.
• Uses holistic approach to determine referral to clinical resources for function.
• Consults with supervisor and others to overcome barriers and presents cases at conferences.
• Adheres to case management processes and regulatory/company policies.

Skills

RN licensure

Case management

Critical care

Telephonic assessment

Team collaboration

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Job description

CVS Health is seeking a Case Manager - Registered Nurse (RN) for a fully remote role with our National Medical Excellence (NME) team. The role blends case management and utilization management to assess, plan, implement, and coordinate care for members to support overall wellness.

Candidates from any state are welcome; compact RN licensure is required with 5+ years RN experience and 2+ years in critical care preferred. Weekday hours and comprehensive benefits offered.