Remote RN Case Manager: Telephonic Care Coordination

CVS Health; Montpelier (VT); Remote; USD 54,000 - 156,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Wellness programs

Job summary

CVS Health is seeking an experienced Registered Nurse Case Manager for a remote, full-time role anywhere in the United States. The incumbent will support members across multiple states, applying clinical guidelines and case management plans to coordinate care for self-insured and fully insured clients.

Responsibilities include telephonic case management, medical necessity reviews, and motivational interviewing to maximize engagement.

Qualifications

• 5+ years' experience as a Registered Nurse, including at least 1 year in a hospital setting.
• RN with multistate license via Nurse Licensure Compact (NLC) or state-specific licensure for each state supported.
• 1+ years' experience documenting electronically using a keyboard.
• 1+ years' current or previous experience in Oncology.

Responsibilities

• Work as a telephonic case manager with patients and care teams for fully and/or self-insured clients.
• Apply criteria, clinical guidelines, care management plans, policies, and regulatory standards to assess benefits and member needs.
• Use clinical judgment to design strategies to reduce risk factors and address complex health indicators.
• Conduct assessments addressing multiple conditions and comorbidities.
• Escalate issues and present cases at conferences for multidisciplinary input.
• Collaborate with clinical colleagues and supervisors to overcome barriers to goals and objectives.
• Follow case management processes in line with policies and regulatory requirements.
• Use motivational interviewing to maximize member engagement and determine health needs.
• Identify and escalate member needs following set guidelines.
• Proactively reach out to members to guide their care.
• Perform medical necessity reviews.

Skills

Nurse case management

Electronic charting

Oncology

Bilingual Spanish

Education

Diploma or Associates Degree in Nursing

Tools

MCG

NCCN

Lexicomp

Job description

CVS Health is seeking an experienced Registered Nurse Case Manager for a remote, full-time role anywhere in the United States. The incumbent will support members across multiple states, applying clinical guidelines and case management plans to coordinate care for self-insured and fully insured clients.

Responsibilities include telephonic case management, medical necessity reviews, and motivational interviewing to maximize engagement.