Remote RN Case Manager — Telephonic Care Navigator

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

Job summary

CVS Health is seeking a Telephonic RN Case Manager to support fully and self-insured clients nationwide from a home office. This remote role involves evaluating member needs, applying clinical guidelines, and coordinating care with diverse health teams.

The position requires 5+ years as a Registered Nurse, an active multistate license, and oncology experience. You will work with medical directors, perform case management activities, and ensure timely access to benefits and services for members.

Qualifications

• 5+ years of RN experience, including hospital setting.
• Active multistate license via NLC for practice across states.
• Experience documenting electronically with a keyboard.
• Oncology experience preferred.

Responsibilities

• Telephonic case management with patients and care teams for clients.
• Apply criteria, clinical guidelines, and regulatory standards to benefits.
• Use clinical judgment to reduce risk factors and plan care.
• Assess conditions across co-morbidities impacting functionality.
• Consult with supervisors and conferences for care outcomes.
• Collaborate with colleagues to overcome barriers to goals.
• Follow case management processes per policies and procedures.
• Use motivational interviewing to engage members.
• Identify and escalate member needs per guidelines.
• Reach out to members to guide their care.
• Perform medical necessity reviews.

Skills

Registered Nurse

RN Case Management

Multistate license (NLC)

Electronic documentation

Oncology experience

Education

Diploma or Associates Degree in Nursing

Tools

MCG

NCCN

Lexicomp

Job description

CVS Health is seeking a Telephonic RN Case Manager to support fully and self-insured clients nationwide from a home office. This remote role involves evaluating member needs, applying clinical guidelines, and coordinating care with diverse health teams.

The position requires 5+ years as a Registered Nurse, an active multistate license, and oncology experience. You will work with medical directors, perform case management activities, and ensure timely access to benefits and services for members.