Remote RN Case Manager - Telephonic Care

CVS Health; Jackson (MS); Remote; USD 54,000 - 156,000; Full time

Benefits offered by this job

Medical benefits

Dental and vision coverage

Retirement savings

Job summary

CVS Health is seeking a remote RN Case Manager to support members across multiple states. This full-time role involves telephonic case management, applying guidelines, and collaborating with clinicians to optimize care.

Ideal candidates have 5+ years as an RN (1+ year in hospital), oncology experience, and an active multistate license or state licenses. Strong documentation and clinical judgment are essential.

Qualifications

• Must be a Registered Nurse with 5+ years of experience, including 1+ year in a hospital setting.
• Active multistate license via NLC or individual state licenses for each state supported.
• Experience documenting electronically using a keyboard for case management.
• 1+ years' experience in Oncology.
• RN Case Manager supports members across multiple states.

Responsibilities

• Telephonic case management with patients and care teams for fully and/or self-insured clients.
• Apply criteria and clinical guidelines to assess benefits and member needs.
• Use clinical judgment to reduce risk factors and address barriers in care planning.
• Assess conditions from multiple sources, including co-morbidities, to inform care.
• Escalate needs per guidelines and participate in case conferences for multidisciplinary input.
• Collaborate with clinical colleagues and supervisors to overcome barriers to goals.
• Follow case management processes compliant with regulatory and company policies.
• Use motivational interviewing to engage members and assess health status.
• Actively reach out to members to guide their care and perform medical necessity reviews.

Skills

Registered Nurse

Case management

Multistate license (NLC)

Oncology experience

Electronic documentation

Education

Diploma or Associates Degree in Nursing

Job description

CVS Health is seeking a remote RN Case Manager to support members across multiple states. This full-time role involves telephonic case management, applying guidelines, and collaborating with clinicians to optimize care.

Ideal candidates have 5+ years as an RN (1+ year in hospital), oncology experience, and an active multistate license or state licenses. Strong documentation and clinical judgment are essential.