Remote RN Case Manager — Telephonic Care Navigator

CVS Health Corporation; Jackson (MS); Remote; USD 54,000 - 156,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Benefits information provided during申请

Job summary

CVS Health Corporation is seeking a remote RN Case Manager to work with patients and care teams across fully and self-insured clients. The role emphasizes applying clinical guidelines, coordinating care, and ensuring medical necessity reviews are completed.

The ideal candidate has 5+ years as a Registered Nurse, an active multistate license under NLC, and experience in oncology, transplant, or related fields. A bilingual Spanish capability is a plus.

Qualifications

• 5+ years’ experience as a Registered Nurse.
• RN must hold an active multistate license via the Nurse Licensure Compact (NLC).
• 1+ years’ experience documenting electronically using a keyboard.
• 1+ years’ experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/Substance Abuse or Maternity/Obstetrics.

Responsibilities

• Telephonic case management with patients and care teams for fully or self-insured clients.
• Apply criteria, clinical guidelines, care plans, and regulatory standards 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 and functionality.
• Consult with supervisors and multidisciplinary teams to meet goals and coordinate care.
• Engage members to guide their care and perform medical necessity reviews.

Skills

Registered Nurse

Case Management

Multistate license

Oncology/Transplant/UR experience

Spanish bilingual (preferred)

Education

Nursing diploma or Associates Degree in Nursing

Job description

CVS Health Corporation is seeking a remote RN Case Manager to work with patients and care teams across fully and self-insured clients. The role emphasizes applying clinical guidelines, coordinating care, and ensuring medical necessity reviews are completed.

The ideal candidate has 5+ years as a Registered Nurse, an active multistate license under NLC, and experience in oncology, transplant, or related fields. A bilingual Spanish capability is a plus.