Remote RN Case Manager – Telephonic Care Coordination

ISHE; Boise (ID); Remote; USD 54,000 - 156,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

PTO

Job summary

CVS Health (American Health Holding, Inc) is hiring a remote RN Case Manager to work telephonically with members across the US. You will assess, plan, and coordinate care for fully and self-insured clients, using guidelines and clinical judgment.

The role requires 5+ years RN experience, state licenses, and experience in Oncology/Transplant or related fields. Hybrid/remote work with full-time hours, 40 weekly.

Qualifications

• 5+ years' experience as a Registered Nurse with at least 1 year of hospital experience.
• Active multistate license via NLC for practice across participating states.
• 1+ years' experience documenting electronically.
• 1+ years' experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Med-Surg, Behavioral Health/Substance Abuse or Maternity obstetrics.

Responsibilities

• Serve as telephonic case manager for fully or self-insured clients.
• Apply criteria and clinical guidelines to assess benefits and needs.
• Use clinical judgment to reduce risk factors and plan care.
• Assess all conditions, incl. co-morbidities, affecting functionality.
• Consult with supervisors and team to meet goals and resolve issues.
• Collaborate with clinical colleagues to overcome barriers to care.
• Follow case management processes per policies and regulations.
• Use motivational interviewing to engage members and assess health needs.
• Identify and escalate member needs per guidelines.
• Proactively outreach to members to guide care.
• Perform medical necessity reviews.

Skills

Registered Nurse

Multistate license (NLC)

Electronic documentation

Oncology/Transplant/Med-Surg/BH/Mater‍

Education

Nursing diploma or Associate’s Degree in Nursing

Tools

Electronic charting

Job description

CVS Health (American Health Holding, Inc) is hiring a remote RN Case Manager to work telephonically with members across the US. You will assess, plan, and coordinate care for fully and self-insured clients, using guidelines and clinical judgment.

The role requires 5+ years RN experience, state licenses, and experience in Oncology/Transplant or related fields. Hybrid/remote work with full-time hours, 40 weekly.