Remote RN Case Manager — Telephonic Care Coordination

CVS Health Corporation; Hartford (CT); Remote; USD 54,000 - 156,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

PTO

Retirement plans

Wellness programs

Job summary

CVS Health is seeking a Remote RN Case Manager to support members across the United States, with virtual training provided. This role focuses on coordinating care for fully and self-insured clients, using established criteria and clinical guidelines to ensure appropriate benefits and outcomes.

The ideal candidate will have 5+ years of RN experience (including hospital settings), an active multistate license, and oncology exposure, with fluency in electronic documentation and strong communication

Qualifications

• Active RN license with multi-state eligibility per NLC.
• Minimum 5 years RN experience, including hospital and oncology exposure.
• Experience documenting electronically; strong communication and organization.

Responsibilities

• Provide telephonic case management for fully and self-insured clients.
• Assess benefits and member needs using criteria, guidelines, and policies.
• Apply clinical judgment to reduce risk factors in care plans.
• Coordinate with care team; present cases at multi-disciplinary conferences.
• Utilize case management processes per regulatory and company guidelines.
• Engage members with motivational interviewing to address health needs.
• Perform medical necessity reviews.

Skills

RN license

Multistate license (NLC)

Oncology experience

Electronic documentation

Care coordination

Telephonic case management

Education

Diploma or Associates Degree in Nursing

Tools

EMR systems

MCG/URAC/CCM guidelines

NCCN/Lexicomp

Job description

CVS Health is seeking a Remote RN Case Manager to support members across the United States, with virtual training provided. This role focuses on coordinating care for fully and self-insured clients, using established criteria and clinical guidelines to ensure appropriate benefits and outcomes.

The ideal candidate will have 5+ years of RN experience (including hospital settings), an active multistate license, and oncology exposure, with fluency in electronic documentation and strong communication