Remote RN Case Manager - Telephonic Care

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

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health seeks a remote RN Case Manager to work from home across the United States with virtual training. American Health Holding, Inc., a CVS Health division, supports cost-effective quality care for members.

You will coordinate care telephonically for fully and self-insured clients, applying clinical guidelines, and collaborating with clinicians to reduce risk and barriers while ensuring regulatory compliance. Oncology experience is preferred.

Qualifications

• RN with 5+ years of nursing experience, including hospital setting.
• Must hold active RN license across states per NLC for compact states or separate state licenses.
• Experience documenting electronically (keyboard).
• Oncology experience desired.

Responsibilities

• Serve as telephonic case manager for fully and self-insured clients.
• Apply criteria, guidelines, and policies to determine benefits and member needs.
• Address barriers and risk factors to support care planning and outcomes.
• Assess conditions using information from multiple sources and coordination with care team.
• Escalate needs and present cases at conferences for multidisciplinary input.
• Collaborate with clinical colleagues to overcome barriers and meet goals.
• Perform medical necessity reviews and ensure regulatory compliance.

Skills

Telephonic care coordination

Clinical judgment

Motivational interviewing

Multistate license

Education

Diploma/Associates Nursing

Job description

CVS Health seeks a remote RN Case Manager to work from home across the United States with virtual training. American Health Holding, Inc., a CVS Health division, supports cost-effective quality care for members.

You will coordinate care telephonically for fully and self-insured clients, applying clinical guidelines, and collaborating with clinicians to reduce risk and barriers while ensuring regulatory compliance. Oncology experience is preferred.