Remote RN Case Manager — Telephonic Care Coordinator

CVS Health Corporation; Providence (RI); Remote; USD 54,000 - 156,000; Full time

Job summary

CVS Health, through American Health Holding, Inc (AHH), seeks a remote RN Case Manager to support members nationwide with telephonic care coordination and evidence-based reviews. This role involves applying clinical guidelines, coordinating benefits, and guiding patients and care teams to optimize outcomes.

The ideal candidate has 5+ years as a Registered Nurse, an active multistate license, and oncology experience. Strong electronic documentation and a patient-centered approach are essential.

Qualifications

• 5+ years' RN experience, including at least 1 year in a hospital setting.
• Active multistate license via the Nurse Licensure Compact (NLC) to practice across participating states.
• 1+ years' experience documenting electronically using a keyboard.
• 1+ years' Oncology experience.

Responsibilities

• Work as a telephonic case manager with patients and care teams 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.
• Conduct assessments using information from multiple sources for conditions including co-morbidities.
• Escalate cases and present at conferences for multidisciplinary input.
• Collaborate with clinical colleagues and supervisors to achieve goals.
• Utilize 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 following set guidelines and protocols.
• Proactively reach out to members to guide their care.
• Perform medical necessity reviews.

Skills

Registered Nurse

Multistate License

Spanish (optional)

Education

Diploma or Associates Degree in Nursing

Tools

MCG

NCCN

Lexicomp

Job description

CVS Health, through American Health Holding, Inc (AHH), seeks a remote RN Case Manager to support members nationwide with telephonic care coordination and evidence-based reviews. This role involves applying clinical guidelines, coordinating benefits, and guiding patients and care teams to optimize outcomes.

The ideal candidate has 5+ years as a Registered Nurse, an active multistate license, and oncology experience. Strong electronic documentation and a patient-centered approach are essential.