Remote RN Case Manager - Telehealth Care Coordination

CVS Health; Annapolis (MD); Remote; USD 54,000 - 156,000; Full time

Job summary

CVS Health is seeking an experienced Registered Nurse to join our remote Case Manager team. This telephonic role supports members across multiple states, using evidence-based guidelines to coordinate care and ensure medical necessity reviews are completed.

A multistate license via NLC is required, with a strong background in Oncology and 5+ years of nursing experience. The role offers full-time hours, competitive benefits, and the flexibility of remote work from anywhere in the United States.

Qualifications

• 5+ years' experience as a Registered Nurse, including at least 1 year in a hospital setting.
• Active multistate license through the Nurse Licensure Compact (NLC) or state-specific RN license for each state supported.
• 1+ years' experience documenting electronically using a keyboard.
• 1+ years' current or previous experience in Oncology.

Responsibilities

• Telephonic case manager with patients and care team for fully and/or self-insured clients.
• Apply criteria, clinical guidelines, and care management plans to assess benefits and member needs.
• Use clinical judgment to reduce risk factors and address health indicators impacting care planning.
• Assess information from various sources for all conditions including co-morbidities.
• Escalate and discuss cases with supervisor and multidisciplinary teams.
• Collaborate with clinical colleagues to overcome barriers to goals.
• Follow regulatory and company policies in case management processes.
• Use motivational interviewing to engage members and assess health needs.
• Identify and escalate member needs following guidelines.
• Actively reach out to members to guide their care.
• Perform medical necessity reviews.

Skills

Case management

Nursing assessment

RN licensure

Education

Diploma or Associates Degree in Nursing

Tools

Electronic health records

Job description

CVS Health is seeking an experienced Registered Nurse to join our remote Case Manager team. This telephonic role supports members across multiple states, using evidence-based guidelines to coordinate care and ensure medical necessity reviews are completed.

A multistate license via NLC is required, with a strong background in Oncology and 5+ years of nursing experience. The role offers full-time hours, competitive benefits, and the flexibility of remote work from anywhere in the United States.