Case Manager, Registered Nurse

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

📋 Description

• Facilitate and coordinate comprehensive care by evaluating member needs, crafting personalized care plans, and managing services across healthcare providers.

• Advocate for patients, ensuring effective communication, optimal resource utilization, and ongoing progress monitoring.

• Serve as the intermediary among members, clients, families, employers, providers, insurance companies, and healthcare personnel.

• Oversee case management activities for catastrophic cases and members with chronic illnesses throughout their care continuum.

• Organize consultant referrals, home care visits, community resources, and alternative levels of care.

• Engage with members via telephone or in person, including home visits, worksite visits, or physician office visits as necessary.

• Evaluate medical and vocational status, creating care plans aimed at enhancing wellness, improving medical outcomes, facilitating return to work, and achieving functional outcomes.

• Communicate with medical providers, attorneys, employers, and insurance carriers.

• Prepare necessary casework documentation.

• Collaborate with internal multidisciplinary teams.

• Reach out to treating physicians or specialists regarding care and treatment.

• Provide education and information on prevention.

• Implement laws, regulations, insurer instructions, and company policies that govern rehabilitation and case management.

• Assess needs and benefit-plan eligibility using clinical tools and data.

• Develop proactive action plans and track progress toward desired outcomes.

⛳️ Requirements

• Active and unrestricted Compact Registered Nurse (RN) Licensure in the state of residence (PA, OH, FL, NJ, GA, NC, TX, CT).

• A minimum of 3 years of clinical practical experience preferred, including areas such as diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac, or home health, particularly with Medicare members.

• At least 2 years of experience in case management, discharge planning, and/or home health care coordination.

• Proficient in Microsoft Word, Excel, Outlook, PowerPoint, and proprietary applications.

• Capability to thrive in a fast-paced, high-volume environment using effective time management and prioritization skills.

• Strong computer skills, including navigating multiple systems and keyboarding.

• Solid understanding of problem-solving and decision-making processes.

• Familiarity with medical terminology.

• Competence in digital literacy skills.

• Ability to interact tactfully with customers and the community.

• Capacity to manage sensitive information with ethics and responsibility.

• Skill in evaluating relative costs and benefits of various actions.

• National professional certification (CRC, CDMS, CRRN, COHN, or CCM) preferred.

• Excellent analytical and problem-solving abilities preferred.

• Strong communication, organizational, and interpersonal skills preferred.

• Bilingual in Spanish preferred.

• An Associate's Degree in Nursing is required.

• A Bachelor's Degree in Nursing is preferred.

• Direct/hardwired internet connection within 7 feet of the modem/router, with minimum speeds of 25 Mbps download and 3 Mbps upload.

• A quiet, secure, and designated home workspace that complies with CVS Health and HIPAA guidelines.

• Ability to work within the state and city of current residence.

• Proficiency in using multiple monitors and applications.

• Experience with Microsoft Office 365 or similar Google Workspace applications.

• Ability to access secure systems such as VPN and EHR portals while adhering to security protocols.

• Competence in troubleshooting common technical issues and reaching out to IT as needed.

• Willingness to learn new skills as the workplace evolves.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

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

• Company-provided equipment (keyboard, monitor, computer, headset, etc.).