Remote RN Case Manager - Telephonic Care Navigator

CVS Health; Tallahassee (FL); 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

Job summary

CVS Health is hiring a remote RN Case Manager to work from home across the United States. You will manage telephonic cases for fully or self-insured clients, applying clinical guidelines and utilizing care plans to optimize member health outcomes.

Requires 5+ years as an RN with multi-state licensure and experience in oncology, transplant, or related areas. Full-time with a comprehensive benefits package and remote training.

Qualifications

• 5+ years' experience as a Registered Nurse with hospital exposure.
• Active multistate RN license via NLC for multi-state support.
• 1+ years' experience documenting electronically.
• Experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/Substance Abuse or Maternity/Obstetrics preferred.

Responsibilities

• Provide telephonic case management with patients and care teams for fully or self-insured clients.
• Apply clinical criteria, guidelines, and care management plans 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 co-morbidity and functional impact.
• Consult with supervisors and multidisciplinary teams to meet goals and objectives.
• Utilize case management processes in compliance with policies and procedures.
• Use motivational interviewing to maximize member engagement and assess health status and needs.
• Escalate member needs following guidelines and protocols.
• Proactively reach out to members to guide their care and perform medical necessity reviews.

Skills

Telephonic case management

Multistate RN license (NLC)

Electronic charting

Healthcare knowledge

Education

Nursing diploma or Associate's Degree in Nursing

Bachelor's degree preferred

Tools

MCG

NCCN

Lexicomp

Job description

CVS Health is hiring a remote RN Case Manager to work from home across the United States. You will manage telephonic cases for fully or self-insured clients, applying clinical guidelines and utilizing care plans to optimize member health outcomes.

Requires 5+ years as an RN with multi-state licensure and experience in oncology, transplant, or related areas. Full-time with a comprehensive benefits package and remote training.