Case Manager, Registered Nurse

Key Responsibilities

• Dedicated to 50-75% of the day to telephonic engagement with members and coordinating their care.
• Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member’s identified needs.
• Provides evidence-based disease management education and support to help the member achieve health goals.
• Ensures the appropriate members of the interdisciplinary care team are involved in the member’s care.
• Supports a seamless health care experience for the member by meticulous documentation of care management activity in the member’s electronic health record.
• Collaborates with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition.
• Identifies and connects members with health plan benefits and community resources.
• Maintains accuracy and timeliness in meeting regulatory requirements within specified timelines.
• Supports other members of the Care Team through clinical decision making and guidance as needed.

Essential Competencies And Functions

• Meets performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements of this role.
• Conducts oneself with integrity, professionalism, and self-direction.
• Exhibits experience or a willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care.
• Familiarity with community resources and services.
• Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records.
• Maintains strong collaborative and professional relationships with members and colleagues.
• Communicates effectively, both verbally and in writing.
• Excellent customer service and engagement skills.

Required Qualifications

• Candidate must have active and unrestricted Registered Nurse (RN) licensure in the state of Pennsylvania (PA) OR Compact Registered Nurse (RN) licensure in state of residence.
• Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the Care Manager Registered Nurse (RN) role.
• Access to a private, dedicated space to conduct work effectively to meet the requirements of the position.
• Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually.
• 3+ years of nursing experience.
• 2+ years of case management, discharge planning and/or home healthcare coordination experience.
• Associate’s of Science in Nursing (ASN) degree AND relevant experience in a health care-related field (REQUIRED).
• Bachelor’s of Science in Nursing (BSN) (PREFERRED).
• Active and unrestricted Registered Nurse (RN) licensure in the state of Pennsylvania (PA) OR Compact Registered Nurse licensure in state of residence.

Preferred Qualifications

• Experience providing care management for Medicare and/or Medicaid members.
• Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health.
• Experience conducting health-related assessments and facilitating the care planning process.
• Bilingual skills, especially English-Spanish.

Additional Information

This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great Benefits For Great People We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.