Remote RN Case Manager — Telephonic Care Coordinator

CVS Health; Concord (NH); Remote; USD 54,000 - 156,000; Full time

Benefits offered by this job

Medical, dental, vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a remote RN Case Manager to support members nationwide from home. You will collaborate with care teams, assess needs, and apply evidence-based guidelines to coordinate benefits and services.

This role requires extensive nursing experience, cross-state licensure, and strong communication. Comprehensive benefits, flexible scheduling, and ongoing virtual training are offered to eligible colleagues.

Qualifications

• 5+ years' RN experience with hospital setting
• Active multistate license through NLC or state-specific licenses for non-compact 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

• Work as telephonic case manager with patients and care team for fully and/or self-insured clients
• Apply criteria, clinical guidelines, care plans, policies and regulatory standards while assessing benefits
• Use clinical judgment to reduce risk factors and barriers in care planning
• Assess conditions and co-morbidities impacting functionality
• Escalate and present cases at conferences for multidisciplinary focus
• Consult with clinical colleagues to overcome barriers to goals
• Follow case management processes in compliance with policies
• Use motivational interviewing to engage members
• Identify and escalate member needs following guidelines
• Actively reach out to members to guide their care
• Perform medical necessity reviews

Skills

Registered Nurse

Multistate license (NLC)

Electronic documentation

Oncology experience

Transplant experience

Pediatrics

Medical/Surgical

Behavioral Health

Maternity/Obstetrics

Education

Nursing diploma or Associates Degree in Nursing

Job description

CVS Health is seeking a remote RN Case Manager to support members nationwide from home. You will collaborate with care teams, assess needs, and apply evidence-based guidelines to coordinate benefits and services.

This role requires extensive nursing experience, cross-state licensure, and strong communication. Comprehensive benefits, flexible scheduling, and ongoing virtual training are offered to eligible colleagues.