Case Manager - Registered Nurse

About the role

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Responsibilities

• 50-75% of the day is dedicated to telephonic engagement with members and the coordination of 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.
• Provides care coordination to support a seamless health care experience for the member.
• Meticulously documents care management activity in the member’s electronic health record.
• Collaborate 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 strong collaborative and professional relationships with members and colleagues.
• Communicate effectively, both verbally and in writing.

Requirements

• Candidate must have active and unrestricted Compact Registered Nurse (RN) licensure in the 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 (CM RN) role.
• 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.
• Excellent customer service and engagement skills.

Qualifications

• 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 Compact Registered Nurse (RN) licensure in the state of residence.