Remote RN Case Manager – Telephonic Care Coordination

CVS Health; Topeka (KS); Remote; USD 54,000 - 156,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Comprehensive benefits package

Job summary

CVS Health is seeking a remote RN Case Manager to provide telephonic care coordination for members across multiple states. This full-time role requires an RN with oncology experience and multistate licensure, documenting electronically and applying clinical guidelines to ensure appropriate benefits.

The position includes a comprehensive benefits package, virtual training, and a 40-hour work week. Prior case management and URAC-related credentials are a plus.

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) or state-specific RN licenses for each state supported.
• 1+ years' experience documenting electronically using a keyboard.
• 1+ years' experience in Oncology.

Responsibilities

• Act as a telephonic case manager for fully and/or self-insured clients.
• Apply criteria, clinical guidelines, and care management plans to assess benefits and member needs.
• Use clinical judgment to reduce risk factors and address barriers in care planning.
• Assess information from multiple sources to address all conditions affecting functionality.
• Escalate cases to supervisors and participate in case conferences for multidisciplinary input.
• Collaborate with clinical colleagues and programs to overcome barriers to goals.
• Follow case management processes in line with regulatory and company policies.
• Use motivational interviewing to maximize member engagement and assess health needs.
• Identify and escalate member needs per guidelines and protocols.
• Proactively reach out to members to guide their care.
• Conduct medical necessity reviews.

Education

Diploma or Associate Degree in Nursing

Job description

CVS Health is seeking a remote RN Case Manager to provide telephonic care coordination for members across multiple states. This full-time role requires an RN with oncology experience and multistate licensure, documenting electronically and applying clinical guidelines to ensure appropriate benefits.

The position includes a comprehensive benefits package, virtual training, and a 40-hour work week. Prior case management and URAC-related credentials are a plus.