Case Manager Registered Nurse - Remote

About the Role

Community Care Case Managers use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes.

Responsibilities

• Act as a liaison with member/client/family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.
• Implement and coordinate all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care, including consultant referrals, home care visits, use of community resources, and alternative levels of care.
• Interact with members/clients telephonically or in person; may require in-home, worksite, or physician’s office visits to provide ongoing case management services.
• Assess and analyze injured, acute, or chronically ill members/clients' medical and/or vocational status; develop a plan of care to facilitate appropriate condition management, optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determine eligibility for benefits.
• Communicate with member/client and other stakeholders (e.g., medical providers, attorneys, employers, insurance carriers) telephonically or in person.
• Prepare all required documentation of case work activities.
• Interact and consult with internal multidisciplinary teams to help members/clients maximize best health outcomes.
• Make outreach to treating physicians or specialists concerning course of care and treatment as appropriate.
• Provide educational and prevention information for best medical outcomes.
• Apply all laws and regulations related to the provision of rehabilitation services, including special instructions required by individual insurance carriers and referral sources.
• Conduct evaluations of members/clients’ needs and benefit plan eligibility; facilitate integrative functions using clinical tools and data.
• Utilize case management processes in compliance with regulatory and company policies and procedures.
• Facilitate appropriate condition management, optimize overall wellness and medical outcomes, and support timely return to baseline or optimal function/return to work.
• Develop a proactive course of action to address issues and enhance short- and long-term outcomes, including opportunities to improve overall wellness through integration.
• Monitor member/client progress toward desired outcomes through assessment and evaluation.

Requirements

• Active and unrestricted Compact Registered Nurse (RN) Licensure.
• 3+ years of clinical practical experience, preference for specialties such as diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac, or Home Health with Medicare members.
• 2+ years of case management, discharge planning, and/or home health care coordination experience.
• Proficiency with standard corporate software applications, including Microsoft Word, Excel, Outlook, and PowerPoint, as well as proprietary applications.
• Able to work in a fast-paced, high-volume environment and utilize time management and prioritization skills.
• Efficient and effective computer skills, including navigating multiple systems and keyboarding.

Work From Home Requirements

• Direct/hardwired internet connection to a modem/router within 7 feet of your computer with a minimum download speed of 25 Mbps and upload speed of 3 Mbps. WiFi and satellite internet are not permitted.
• A quiet, secure, and private designated home workspace, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, allowing for uninterrupted work during work hours.
• Work-from-Home colleagues must work within the state and city where they have confirmed they currently live.
• The company will provide equipment (keyboard, monitor, computer, headset, etc.). New hires must provide their own workspace furniture (desk or standing desk).
• Commitment to obtaining required internet speeds and adhering to all Work From Home requirements.

Technical and Logistical Requirements

• Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.
• Ability to communicate via digital channels such as email, calendar invites, Teams messaging, and virtual meetings.
• Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) or similar (Google Workspace).
• Ability to log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
• Ability to resolve common technical issues independently (e.g., restarting frozen applications, resolving internet connection issues) and contact IT for unresolved issues.
• Openness to learning new skills as the workplace environment evolves.

Preferred Qualifications

• Excellent analytical and problem-solving skills.
• Effective communication, organizational, and interpersonal skills.
• Certified Case Manager (CCM) or national professional certification (CRC, CDMS, CRRN, COHN, or CCM).

Education

• Associate's Degree in Nursing or Nursing Diploma (required).
• Bachelor's Degree in Nursing (preferred).

License

Active and unrestricted Compact Registered Nurse (RN) Licensure.

Schedule

• Full time.
• 40 hours per week.

Pay

The typical pay range for this role is $60,522.00 - $129,615.00 annually. This position is also eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range.

Benefits

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, including:

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources.