Remote RN Case Manager - Telephonic Care Coordination

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

Job summary

CVS Health is seeking a Telephonic RN Case Manager to work remotely from anywhere in the United States with virtual training. The role focuses on case management for fully and self-insured clients, applying criteria, guidelines, and policies to optimize member care and benefits.

Ideal candidates have 5+ years as an RN with case management experience, licensed in a compact state or holding multiple licenses as applicable.

Qualifications

• Registered Nurse with 5+ years of experience in case management.
• Active multistate license via NLC or state-specific license for each state supported.
• Experience documenting electronically using a keyboard and EHR systems.
• Experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/Substance Abuse or Maternity/Obstetrics.

Responsibilities

• Telephonic case management with patients and care teams for clients.
• Assess benefits and member needs; apply clinical guidelines and policies.
• Address complex health and social indicators impacting care planning.
• Conduct medical necessity reviews and collaborate with supervisors and teams.

Skills

RN Case Management

Multistate license (NLC)

Electronic documentation (EHR)

Oncology/Transplant/ specialty

Education

Nursing diploma or Associate degree

BSN preferred

Tools

MCG

NCCN Guidelines

Lexicomp

Job description

CVS Health is seeking a Telephonic RN Case Manager to work remotely from anywhere in the United States with virtual training. The role focuses on case management for fully and self-insured clients, applying criteria, guidelines, and policies to optimize member care and benefits.

Ideal candidates have 5+ years as an RN with case management experience, licensed in a compact state or holding multiple licenses as applicable.