Remote RN Case Manager – Telephonic Care Coordination

CVS Health; Alaska; Hybrid; USD 54,000 - 156,000; Full time

Benefits offered by this job

Comprehensive benefits package

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health, a national healthcare leader, seeks an experienced RN Case Manager for a remote role across the United States. You will provide telephonic case management for fully and self-insured clients, coordinating benefits and services while applying clinical guidelines to support quality care.

The role requires an active RN license (NLC preferred or multiple state licenses), a nursing degree, and at least 5 years of RN experience with documentation experience.

Qualifications

• 5+ years as a Registered Nurse with hospital experience.
• Active multistate license via NLC or state-specific licenses.
• 1+ years documenting electronically.
• 1+ years in Oncology, Transplant, Specialty Pharmacy, or related areas.

Responsibilities

• Telephonic case management with patients and care teams for fully or self-insured clients.
• Apply criteria, guidelines, and procedures to determine benefits and member needs.
• Use clinical judgment to design care plans addressing risk factors and barriers.
• Assess conditions from multiple sources to address co-morbidity and functionality.
• Consult with supervisors and teams to overcome barriers and meet goals.
• Collaborate with clinical colleagues and directors to resolve issues.
• Follow regulatory policies in case management processes.
• Use motivational interviewing to engage members and assess health status.
• Identify and escalate member needs per guidelines.
• Actively reach out to members to guide their care.
• Perform medical necessity reviews.

Skills

Telephonic case management

Clinical judgment

Motivational interviewing

Education

Nursing diploma or AS/AA in Nursing

Tools

Electronic health records (EHR)

Job description

CVS Health, a national healthcare leader, seeks an experienced RN Case Manager for a remote role across the United States. You will provide telephonic case management for fully and self-insured clients, coordinating benefits and services while applying clinical guidelines to support quality care.

The role requires an active RN license (NLC preferred or multiple state licenses), a nursing degree, and at least 5 years of RN experience with documentation experience.