Remote RN Case Manager — Telephonic Care Coordination

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

Benefits offered by this job

Medical, dental, and vision coverage

Retirement savings options

Job summary

CVS Health is seeking a Telephonic RN Case Manager to support members across the United States from a remote work setup. You will coordinate care with patients and their care teams, applying guidelines and reviewing medical necessity to optimize benefits and outcomes.

The role requires 5+ years as an RN, an active multistate license, and oncology experience, with electronic documentation in EMR systems. It is a full-time, 40-hour weekly position with competitive benefits.

Qualifications

• 5+ years' experience as a Registered Nurse, including at least 1 year in a hospital setting.
• The AHH RN Case manager position requires the nurse to support members across multiple states. A RN who resides in a compact state is required to have an active multistate license through the Nurse Licensure Compact (NLC), allowing practice across participating states with one license.
• 1+ years' experience documenting electronically using a keyboard.
• 1+ years' current or previous experience in Oncology.

Responsibilities

• Conduct telephonic case management with patients and care teams.
• Assess benefits and member needs to ensure appropriate administration of benefits.
• Apply clinical judgment to strategies to reduce risk factors and barriers.
• Utilize information from multiple sources to address conditions impacting functioning.
• Discuss cases with supervisors and multidisciplinary teams to support care planning.
• Collaborate with clinical colleagues to overcome barriers to goals.
• Follow case management processes in line with policy and regulation.
• Use motivational interviewing to maximize member engagement and assess health status.
• Identify and escalate member needs following guidelines.
• Proactively reach out to members to guide their care.
• Perform medical necessity reviews.

Skills

Registered Nurse

NLC Multistate License

Oncology Experience

Telephonic Case Management

Bilingual in Spanish (Preferred)

Education

Diploma or Associates Degree in Nursing

Tools

Electronic Medical Records (EMR)

Job description

CVS Health is seeking a Telephonic RN Case Manager to support members across the United States from a remote work setup. You will coordinate care with patients and their care teams, applying guidelines and reviewing medical necessity to optimize benefits and outcomes.

The role requires 5+ years as an RN, an active multistate license, and oncology experience, with electronic documentation in EMR systems. It is a full-time, 40-hour weekly position with competitive benefits.