Remote RN Case Manager: Telephonic Care Navigator

CVS Health; Juneau (AK); Remote; USD 54,000 - 156,000; Full time

Job summary

CVS Health is seeking a remote RN Case Manager to serve members across the United States. You will manage cases telephonically, evaluate medical necessity, and coordinate care with care teams for fully and self-insured clients.

The role requires a valid RN license with 5+ years' experience (including hospital), and preference for oncology and utilization review knowledge. A multistate license is preferred; remote work is available nationwide.

Qualifications

• 5+ years' nursing experience including hospital setting.
• Active multistate RN license via NLC preferred; state-specific license if non-compact state.
• Experience documenting electronically.
• Experience in Oncology and utilization management is preferred.

Responsibilities

• Telephonic case management with patients and care team for clients.
• Apply criteria, guidelines, and policies to assess benefits and member needs.
• Use clinical judgment to design strategies to reduce risk and barriers.
• Assess co-morbid conditions and functional impact for care planning.
• Consult with supervisors and teams to overcome barriers and meet goals.
• Utilize case management processes in compliance with policies and regulations.
• Use motivational interviewing to engage members and assess health needs.
• Identify and escalate member needs per guidelines and protocols.
• Actively reach out to members to coordinate care.
• Perform medical necessity reviews.

Skills

RN Case Manager

Oncology

Utilization Review

Multistate license

Electronic documentation

Education

RN Diploma or Associate Degree in Nursing

Job description

CVS Health is seeking a remote RN Case Manager to serve members across the United States. You will manage cases telephonically, evaluate medical necessity, and coordinate care with care teams for fully and self-insured clients.

The role requires a valid RN license with 5+ years' experience (including hospital), and preference for oncology and utilization review knowledge. A multistate license is preferred; remote work is available nationwide.