Remote RN Case Manager – Telephonic Health Navigator

CVS Health; Lincoln (NE); Remote; USD 54,000 - 156,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Vision benefits

Paid time off

Job summary

CVS Health is seeking a qualified Registered Nurse Case Manager for a remote, full-time role across the United States. You will work telephonically with members and care teams, applying clinical guidelines, care plans, and regulatory standards to ensure appropriate benefit administration and high-quality outcomes.

The ideal candidate has 5+ years of RN experience, an active multistate license, and familiarity with oncology, transplant, pediatrics or medical/surgical care.

Qualifications

• 5+ years of RN experience
• Active multistate license (NLC) or state-specific licenses
• 1+ years documenting electronically (EMR)
• Experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/Substance Abuse or Maternity/Obstetrics

Responsibilities

• Telephonic case management with patients and care team
• Apply criteria, care plans, policies and regulatory standards
• Use clinical judgment to reduce risk and address barriers
• Assess multiple conditions impacting functionality
• Escalate and present cases for multidisciplinary focus
• Collaborate with clinical colleagues to overcome barriers
• Follow case management processes in compliance with policies
• Use motivational interviewing to engage members
• Identify and escalate needs per guidelines
• Proactively reach out to members for care guidance
• Perform medical necessity reviews

Skills

Registered Nurse

NLC multistate license

EMR documentation

Oncology experience

Transplant experience

Pediatrics experience

Medical/Surgical experience

Behavioral Health experience

Education

Nursing diploma or Associate Degree in Nursing

Bachelor's degree preferred

Tools

MCG

NCCN

Lexicomp

Job description

CVS Health is seeking a qualified Registered Nurse Case Manager for a remote, full-time role across the United States. You will work telephonically with members and care teams, applying clinical guidelines, care plans, and regulatory standards to ensure appropriate benefit administration and high-quality outcomes.

The ideal candidate has 5+ years of RN experience, an active multistate license, and familiarity with oncology, transplant, pediatrics or medical/surgical care.