Remote RN Case Manager - Telephonic Care Coordination

CVS Health; Pierre (SD); Remote; USD 54,000 - 156,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off and retirement options

Wellness programs and additional self‑

Benefits for dependents

Job summary

CVS Health is seeking an experienced RN Case Manager for a remote, work-from-home role across the United States. You will manage telephonic care for fully or self-insured clients, applying clinical guidelines and regulatory standards to optimize benefits and outcomes.

You will collaborate with supervisors, Medical Directors, and care teams to address barriers, support members, and complete medical necessity reviews while maintaining documentation electronically and adhering to URAC standards.

Qualifications

• 5+ years' experience as a Registered Nurse with at least 1 year of hospital setting experience.
• The nurse must hold an active multistate license through the Nurse Licensure Compact (NLC) to practice across participating states.
• 1+ years' experience documenting electronically.
• 1+ years' experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/Substance Abuse or Maternity/ Obstetrics.

Responsibilities

• Conduct telephonic case management with patients and care teams for fully or self-insured clients.
• Apply criteria, clinical guidelines, and regulatory standards to assess benefits and member needs.
• Use clinical judgment to reduce risk factors and barriers in care planning.
• Assess functional impact of co-morbid conditions on member care.
• Consult with supervisors and colleagues to overcome barriers and improve outcomes.

Skills

NLC license (Nurse Licensure Compact)

Case management

Electronic documentation

RN with multi-state practice

Education

Nursing diploma or Associate's Degree in Nursing

Tools

MCG

NCCN

Lexicomp

Job description

CVS Health is seeking an experienced RN Case Manager for a remote, work-from-home role across the United States. You will manage telephonic care for fully or self-insured clients, applying clinical guidelines and regulatory standards to optimize benefits and outcomes.

You will collaborate with supervisors, Medical Directors, and care teams to address barriers, support members, and complete medical necessity reviews while maintaining documentation electronically and adhering to URAC standards.