Remote RN Case Manager | Telephonic Care Coordination

CVS Health; Maine; Hybrid; USD 54,000 - 156,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision coverage

Paid time off

Retirement plan

Job summary

CVS Health is seeking an experienced RN Case Manager to provide telephonic care management for members across multiple states, leveraging evidence-based guidelines and a holistic approach.

Role emphasizes collaboration with medical directors and care teams, utilization review, and proactive member engagement to improve outcomes. Remote work from anywhere in the US with full training is provided.

Qualifications

• 5+ years’ experience as a Registered Nurse with at least 1 year in a hospital setting.
• Active multistate license via NLC for compact states; otherwise state-specific licenses.
• 1+ years’ experience documenting electronically.
• 1+ years’ experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Med/Surg, Behavioral Health/Substance Abuse or Maternity/Obstetrics.

Responsibilities

• This role is a telephonic case manager interacting with patients and care teams.
• Apply criteria, guidelines, and policies to assess benefits and members’ needs.
• Use clinical judgment to design strategies addressing risk factors and barriers.
• Assess multiple conditions impacting functionality and care plans.
• Consult with supervisors and multidisciplinary teams to achieve goals.
• Collaborate with clinical colleagues to overcome barriers to goals.
• Follow regulatory and company policies in case management processes.
• Utilize motivational interviewing to engage members and assess health needs.
• Identify and escalate member needs per guidelines, proactively reaching out.
• Perform medical necessity reviews.

Skills

RN experience

Telephonic case management

Multistate license

Oncology / Transplant familiarity

Electronic documentation

Spanish preferred

Education

Nursing diploma or Associates Degree in Nursing

Tools

MCG

NCCN

Lexicomp

Job description

CVS Health is seeking an experienced RN Case Manager to provide telephonic care management for members across multiple states, leveraging evidence-based guidelines and a holistic approach.

Role emphasizes collaboration with medical directors and care teams, utilization review, and proactive member engagement to improve outcomes. Remote work from anywhere in the US with full training is provided.