Remote RN Case Manager: Elevate Community Care

CVS Health; Springfield (IL); Remote; USD 67,000 - 143,000; Full time

Job summary

CVS Health is seeking an experienced Registered Nurse Case Manager in Illinois to coordinate comprehensive care for Medicare members. You will assess needs, develop personalized care plans, and work with providers, nurses, and insurers to ensure quality outcomes.

Responsibilities include coordinating hospital-to-home transitions, documenting care plans, and advocating for patients while navigating regulatory requirements. Strong clinical background and communication skills are essential.

Qualifications

• Active and unrestricted RN licensure in Illinois
• 3+ years of clinical practical experience (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac, Home Health) with Medicare members
• 2+ years of case management, discharge planning and/or home health care coordination experience
• Proficiency with standard corporate software applications, including Microsoft Word, Excel, Outlook and PowerPoint, as well as some proprietary applications
• Able to work in a fast paced high volume environment with time management and prioritization skills
• Efficient computer skills including navigating multiple systems and keyboarding
• Working knowledge of medical terminology and digital literacy
• Ability to deal tactfully with customers and maintain ethics and confidentiality
• Ability to assess options and select appropriate actions for patient care

Responsibilities

• Acts as a liaison with member/family, employer, provider, insurer, and healthcare personnel
• Coordinates case management activities for catastrophic and chronically ill members across the continuum of care
• Interacts with members telephonically or in person and may visit homes or offices
• Assesses medical and vocational status; develops a plan to facilitate wellness and return to baseline
• Communicates with medical providers, attorneys, employers, and insurers
• Prepares documentation of case work activities
• Collaborates with internal multidisciplinary team to optimize health outcomes
• Outreaches to treating physicians or specialists as appropriate
• Provides educational and preventive information for best outcomes
• Applies laws and regulations for rehabilitation services and carrier requirements
• Evaluates needs for benefit plan eligibility and coordinates care across sites
• Monitors progress and adjusts plans to maximize wellness and outcomes
• Develops proactive actions to enhance long-term outcomes and overall wellness

Skills

Case management

Discharge planning

Home health coordination

MS Office

Time management

Communication

Medical terminology

Digital literacy

Teamwork

Care coordination

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Tools

Microsoft Word

Excel

Outlook

PowerPoint

Job description

CVS Health is seeking an experienced Registered Nurse Case Manager in Illinois to coordinate comprehensive care for Medicare members. You will assess needs, develop personalized care plans, and work with providers, nurses, and insurers to ensure quality outcomes.

Responsibilities include coordinating hospital-to-home transitions, documenting care plans, and advocating for patients while navigating regulatory requirements. Strong clinical background and communication skills are essential.