Remote RN Case Manager — Telephonic Care Coordinator

CVS Health; Hartford (CT); Remote; USD 54,000 - 156,000; Full time

Benefits offered by this job

Comprehensive benefits

Remote work from home

Ongoing training and development

Job summary

CVS Health is seeking a remote RN Case Manager to support members across the United States. You will perform telephonic case management for fully or self-insured clients, applying clinical guidelines and care plans to ensure appropriate benefits and high-quality care.

The role requires 5+ years as a registered nurse, an active multi-state license or state-specific licenses, and experience with electronic documentation. Full-time with a comprehensive benefits package is offered.

Qualifications

• RN with 5+ years of experience, 1 year in a hospital setting.
• Active multi-state license through the NLC or state-specific license for each state supported.
• 1+ years documenting electronically in an EHR.
• Experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health, or Maternity/Obstetrics.

Responsibilities

• Perform telephonic case management for fully and/or self-insured clients.
• Apply criteria and clinical guidelines to assess benefits and member needs.
• Use holistic care planning to reduce risk factors and resolve issues.
• Assess information from multiple sources for comprehensive care plans.
• Escalate and discuss cases in case conferences for multidisciplinary input.
• Collaborate with clinicians and supervisors to overcome barriers.
• Ensure compliance with regulatory standards and company policies.
• Conduct medical necessity reviews.

Skills

Registered Nurse

Case management

Telephonic care coordination

Electronic health records

Multistate license (NLC)

Education

Nursing diploma or Associates degree

Tools

Electronic health records

Computer literacy

Job description

CVS Health is seeking a remote RN Case Manager to support members across the United States. You will perform telephonic case management for fully or self-insured clients, applying clinical guidelines and care plans to ensure appropriate benefits and high-quality care.

The role requires 5+ years as a registered nurse, an active multi-state license or state-specific licenses, and experience with electronic documentation. Full-time with a comprehensive benefits package is offered.