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 coverage

Dental coverage

Vision coverage

Paid time off

Retirement plan

Wellness programs

Job summary

CVS Health is seeking a remote RN Case Manager to support telephonic care management for fully and self-insured clients across multiple states. This full-time role includes reviewing medical necessity, applying clinical guidelines, and coordinating care with the member's care team.

The ideal candidate has 5+ years as an RN (multistate license via NLC preferred) and at least 1 year of experience in hospital settings, oncology, transplant, or related fields.

Qualifications

• RN with 5+ years' experience (hospital setting preferred).
• Active multistate license via NLC or state-specific licenses required.
• 1+ years' experience documenting electronically.
• 1+ years' experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/Substance Abuse or Maternity/ Obstetrics.

Responsibilities

• Telephonic case management with patients and care team for clients.
• Assess benefits and member needs to ensure appropriate benefits administration.
• Apply clinical judgment to reduce risk factors and barriers in care planning.
• Address co-morbid conditions and complex health indicators in care plans.
• Consult with supervisors/Medical Directors and programs to overcome barriers and meet goals.
• Follow case management processes in compliance with policies and procedures.
• Use motivational interviewing to maximize member engagement.
• Identify and escalate member needs per guidelines and protocols.
• Outbound outreach to members to guide their care.
• Perform medical necessity reviews.

Skills

Telephonic communication

Motivational interviewing

Clinical judgment

Care coordination

Documentation

Education

RN licensure (NLC preferred)

Nursing diploma/ADN

Tools

Electronic documentation

Job description

CVS Health is seeking a remote RN Case Manager to support telephonic care management for fully and self-insured clients across multiple states. This full-time role includes reviewing medical necessity, applying clinical guidelines, and coordinating care with the member's care team.

The ideal candidate has 5+ years as an RN (multistate license via NLC preferred) and at least 1 year of experience in hospital settings, oncology, transplant, or related fields.