Remote RN Case Manager: Telephonic Care Coordination

CVS Health; Dover (DE); Remote; USD 54,000 - 156,000; Full time

Job summary

CVS Health is seeking a remote RN Case Manager to support telephonic case management for fully and self-insured clients, applying clinical guidelines and care plans to optimize benefits and member outcomes. The role requires 5+ years as an RN, multi-state licensure, 1+ year of electronic documentation, and experience in oncology, transplant, or related fields.

A nursing diploma or associate degree is required; bachelor’s preferred.

Qualifications

• 5+ years' experience as a Registered Nurse.
• Active multistate license via NLC or state-specific licenses for each state supported.
• 1+ year' experience documenting electronically (EMR).
• 1+ years' experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/Substance Abuse or Maternity/Obstetrics.

Responsibilities

• Telephonic case management with patients and care team for fully and/or self-insured clients.
• Apply criteria, clinical guidelines, care plans, and regulatory standards to assess benefits and member needs.
• Use clinical judgment to address risk factors and barriers in care planning.
• Assess information from multiple sources to address all conditions affecting functionality.
• Escalate issues and present cases at case conferences for multidisciplinary input.
• Consult with clinical colleagues and supervisors to overcome barriers to goals.
• Follow case management processes in compliance with policies.
• Use motivational interviewing to maximize member engagement and determine health status.

Skills

Registered Nurse experience

Multistate licensure (NLC)

Electronic documentation

Oncology/Transplant/Specific care

Spanish bilingual (preferred)

Education

Nursing diploma or Associate degree

Bachelor's degree preferred

Tools

EMR documentation

Job description

CVS Health is seeking a remote RN Case Manager to support telephonic case management for fully and self-insured clients, applying clinical guidelines and care plans to optimize benefits and member outcomes. The role requires 5+ years as an RN, multi-state licensure, 1+ year of electronic documentation, and experience in oncology, transplant, or related fields.

A nursing diploma or associate degree is required; bachelor’s preferred.