RN Case Manager — Care Coordination Pro

ANA-Ohio; Ohio; Remote; USD 61,000 - 130,000; Full time

Job summary

CVS Health is seeking a Community Care Case Manager to coordinate comprehensive health services for individuals and families. You will assess needs, plan and implement care, and advocate for access to resources to promote quality, cost-effective outcomes.

The role requires active RN licensure, 3+ years of clinical and 2+ years case management experience, with strong communication and teamwork skills to work across providers, insurers and families.

Qualifications

• Active and unrestricted Compact Registered Nurse (RN) licensure in OH or state of residence.
• 3+ years clinical practical experience in relevant areas (diabetes, CHF, CKD, post-acute, hospice, palliative, cardiac) with Medicare.
• 2+ years case management, discharge planning and/or home health care coordination experience.

Responsibilities

• Acts as liaison with member/family, employer, providers, insurers, and healthcare personnel.
• Coordinates case management activities across catastrophic and chronic cases.
• Interacts with members telephonically or in person; home visits may be required.
• Assesses medical and vocational status; develops care plan to optimize outcomes.
• Communicates with stakeholders (providers, attorneys, employers, insurers) as needed.
• Prepares documentation of case work activities; maintains compliance with policies.
• Collaborates with internal multidisciplinary team to maximize health outcomes.
• Outreach to treating physicians or specialists as appropriate.
• Provides education and prevention information for medical outcomes.
• Applies laws and regulations relevant to rehabilitation services and insurer requirements.
• Testifies to substantiate case work or reports.
• Evaluates needs and benefit plan eligibility; facilitates integrative functions.

Skills

Communication skills

Team collaboration

MS Office

EHR proficiency

Spanish (optional)

Education

Associate's Degree or Nursing Diploma

Bachelor's Degree (preferred)

Tools

MS Word

Excel

Outlook

PowerPoint

EHR portal

Job description

CVS Health is seeking a Community Care Case Manager to coordinate comprehensive health services for individuals and families. You will assess needs, plan and implement care, and advocate for access to resources to promote quality, cost-effective outcomes.

The role requires active RN licensure, 3+ years of clinical and 2+ years case management experience, with strong communication and teamwork skills to work across providers, insurers and families.