Care Manager – Registered Nurse

This is a fully remote position, open to applicants in Missouri.

📋 Description

• Perform thorough evaluations of members with chronic medical, behavioral health, and social determinants of health requirements.

• Engage with members via telephone and oversee care coordination for 50–75% of the working day.

• Gather clinical data and create personalized care plans in collaboration with members.

• Deliver evidence-based education and support for disease management.

• Involve relevant interdisciplinary care team members as necessary.

• Facilitate care coordination to ensure a smooth healthcare journey for members.

• Accurately document care management activities in electronic health records in a timely manner.

• Work with the interdisciplinary care team to identify and resolve barriers while maintaining stable health conditions.

• Assist members in accessing health-plan benefits, community resources, and support services.

• Comply with regulatory requirements within designated timelines.

• Provide support to care team members through clinical decision-making and guidance.

• Engage in special projects, process enhancements, and mentorship for new team members.

• Attend team meetings to review member status and strategize care plans.

⛳️ Requirements

• Must possess an active and unrestricted Registered Nurse (RN) license in Missouri or compact licensure in your state of residence.

• A degree of Associate of Science in Nursing (ASN) along with relevant experience in a healthcare-related field is required.

• A minimum of 3+ years of nursing experience is necessary.

• At least 2+ years of experience in case management, discharge planning, and/or home healthcare coordination is required.

• Proficiency in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams.

• Must have access to a private, dedicated workspace.

• Capability to work independently from home while collaborating virtually is essential.

• Ability to meet performance and productivity metrics, including call volume, member engagement, and regulatory obligations.

• Familiarity with community resources and services is advantageous.

• Proficient in utilizing healthcare technology tools and electronic health records.

• Strong verbal and written communication skills are required.

• Excellent customer service and member engagement abilities are essential.

• Experience or willingness to learn about care management within Medicare and Medicaid managed care is preferred.

• A Bachelor's of Science in Nursing (BSN) is preferred.

• Experience with Medicare and/or Medicaid members is advantageous.

• Background in social determinants of health, chronic medical conditions, and/or behavioral health is preferred.

• Experience in conducting health-related assessments and facilitating care planning is preferred.

• Bilingual skills, particularly in English and Spanish, are preferred.

🏝️ Benefits

• Eligible for CVS Health bonus, commission, or short-term incentive program in addition to base salary.

• Comprehensive medical, dental, and vision insurance coverage.

• Paid time off for personal use.

• Retirement savings options available.

• Access to wellness programs.

• Various resources supporting physical, emotional, and financial well-being.

• Flexible work-from-home arrangement.

• Full-time commitment of 40 hours per week.