Case Manager, Registered Nurse

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

📋 Description

• Oversee and facilitate holistic care for individuals by evaluating needs, creating customized care plans, and coordinating services among healthcare providers.

• Champion for patients, ensuring effective communication, optimal resource utilization, and ongoing progress tracking.

• Serve as a liaison between members, clients, families, employers, providers, insurance companies, and healthcare professionals.

• Manage case management activities for complex cases and chronically ill members across the care continuum.

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

• Engage with members and clients through phone or in-person interactions, including at home, work sites, or physician offices.

• Evaluate and analyze medical and/or vocational conditions.

• Create care plans to enhance wellness and medical outcomes, facilitate timely return to work, and ascertain benefit eligibility.

• Communicate with members, clients, and stakeholders, including medical providers, attorneys, employers, and insurance representatives.

• Prepare necessary case documentation.

• Collaborate with internal multidisciplinary teams.

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

• Provide educational resources and preventative information.

• Comply with applicable rehabilitation-service laws, regulations, insurer guidelines, and referral-source requirements.

• Assess member and client needs and evaluate benefit plan eligibility using clinical tools and data.

• Implement case management processes in accordance with regulatory standards and company policies.

• Formulate proactive strategies to enhance short- and long-term outcomes and overall wellness.

• Track progress towards targeted outcomes through assessments and evaluations.

⛳️ Requirements

• Preferred residence in Michigan.

• Active and unrestricted RN licensure in Michigan.

• Active and unrestricted Compact Registered Nurse (RN) Licensure in the state of residence (MI).

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

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

• Strong computer skills, including navigating multiple systems and proficient typing.

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

• Familiarity with medical terminology.

• Competence in digital literacy skills.

• Capability to interact tactfully with customers and the community.

• Ability to manage sensitive information with integrity and responsibility.

• Capacity to evaluate the costs and benefits of potential actions.

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

• A Bachelor's Degree in Nursing is preferred.

• An Associate's Degree in Nursing is required.

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

• A quiet, secure, and private designated home workspace compliant with CVS Health and HIPAA guidelines.

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

• Must provide own workspace furniture.

• Capability to navigate multiple monitors and applications.

• Proficient in using email, calendar invites, Teams messaging, and virtual meeting platforms.

• Experience with Microsoft Office 365 or similar Google Workspace.

• Ability to access secure systems, utilize VPN/EHR portals, manage secure devices, maintain strong passwords, and identify suspicious emails or links.

• Proficient in troubleshooting common technical issues.

• Willingness to learn new skills.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

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

• Eligibility for CVS Health bonus, commission, or short-term incentive programs.