Remote RN Case Manager: Telephonic Care Coordination

CVS Health Corporation; Montgomery (AL); Remote; USD 54,000 - 156,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a remote RN Case Manager to work from home across the United States with virtual training. The role involves telephonic case management for fully insured and self-insured clients, applying clinical guidelines, and coordinating care to improve outcomes.

Requirements include 5+ years of RN experience (1+ year in hospital), an active multistate license via NLC, and experience with electronic documentation and oncology.

Qualifications

• 5+ years' experience as a Registered Nurse, including at least 1 year in a hospital setting.
• Active multistate license through the Nurse Licensure Compact (NLC) to practice across participating states.
• 1+ years' experience documenting electronically.
• 1+ years' experience in Oncology.

Responsibilities

• Work as a telephonic case manager with patients and their care team for fully and/or self-insured clients.
• Apply criteria and clinical guidelines to assess benefits and member needs for appropriate administration of benefits.
• Use clinical judgment to reduce risk factors and address complex health indicators in care planning.
• Assess information from various sources to address all conditions impacting functionality.
• Consult with supervisor and others to overcome barriers and present cases for multidisciplinary focus.
• Maintain compliance with case management processes per regulatory and company policies.
• Use motivational interviewing to maximize member engagement and discern health status and needs.
• Identify and escalate member needs following set guidelines and protocols.
• Actively reach out to members to guide their care and perform medical necessity reviews.

Skills

RN Case Manager

Multistate license (NLC)

Oncology experience

Electronic documentation

Education

Nursing Diploma/Associates

Job description

CVS Health is seeking a remote RN Case Manager to work from home across the United States with virtual training. The role involves telephonic case management for fully insured and self-insured clients, applying clinical guidelines, and coordinating care to improve outcomes.

Requirements include 5+ years of RN experience (1+ year in hospital), an active multistate license via NLC, and experience with electronic documentation and oncology.