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 coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings

Job summary

CVS Health is recruiting a remote RN Case Manager to support members nationwide. The role involves telephonic case management, reviewing medical necessity, and coordinating care with a focus on safety and quality.

AHH provides medical management services within CVS Health. Ideal candidates hold 5+ years as a registered nurse with multi-state licensing and oncology exposure; strong documentation skills and collaboration with care teams are essential.

Qualifications

• Experience in telephonic case management across states.
• Registered Nurse with multi-state licensing as required.
• Oncology exposure is preferred and beneficial.

Responsibilities

• Work as a telephonic case manager with patients and care teams.
• Apply criteria and guidelines to assess benefits and needs.
• Use clinical judgment to reduce risk factors in care planning.
• Assess conditions from multiple sources for comprehensive care.
• Collaborate with supervisors and teams to resolve member issues.
• Engage with clinical colleagues to overcome barriers to goals.
• Follow case management processes compliant with policy.
• Use motivational interviewing to maximize member engagement.
• Identify and escalate member needs per guidelines.
• Proactively reach out to members to guide their care.
• Perform medical necessity reviews.

Skills

Telephonic case management

Clinical nursing

Multistate RN license

Oncology experience

EMR documentation

Education

Diploma or Associate Degree in Nursing

Job description

CVS Health is recruiting a remote RN Case Manager to support members nationwide. The role involves telephonic case management, reviewing medical necessity, and coordinating care with a focus on safety and quality.

AHH provides medical management services within CVS Health. Ideal candidates hold 5+ years as a registered nurse with multi-state licensing and oncology exposure; strong documentation skills and collaboration with care teams are essential.