Case Manager, Registered Nurse

This is a fully remote position, open to applicants in Alabama, +40 more states.

📋 Description

• Evaluate, strategize, execute, and manage case management activities through phone or in-person interactions.

• Assess members’ healthcare requirements to promote overall well-being.

• Create proactive strategies to enhance both short- and long-term health outcomes.

• Analyze clinical tools and information/data to assess member needs and eligibility for benefit plans.

• Support integration and transitions to Aetna programs and plans.

• Utilize clinical judgment to mitigate risk factors and address intricate health and social challenges.

• Evaluate co-morbidities, multiple diagnoses, functionality, work capacity, and any restrictions or limitations.

• Examine previous claims and their possible impact on case management and eligibility.

• Identify the necessity for referrals to clinical resources.

• Collaborate with supervisors and others to resolve barriers.

• Present cases during multidisciplinary case conferences.

• Implement case management processes in adherence to regulatory and company policies.

• Conduct interviews to engage members and assess their health status and needs.

⛳️ Requirements

• Current RN licensure in the state of residence.

• A minimum of 2 years of clinical experience as a registered nurse.

• Multiple state RN licensure is appreciated but not mandatory; if selected, the willingness and capability to acquire it post-hire is required.

• An Associate's Degree in Nursing.

• Availability to work Monday through Friday from 9:00 AM to 5:30 PM in the resident time zone.

• Flexibility for occasional evening, weekend, and holiday shifts.

• Direct/hardwired internet connection to a modem/router within 7 feet of the computer.

• Minimum internet speed of 25 Mbps download and 3 Mbps upload.

• WiFi and satellite internet connections are not acceptable.

• A quiet, secure, private home workspace that complies with CVS Health and HIPAA regulations.

• Capability to work within the state and city of residence.

• Provision of personal workspace furniture.

• Proficiency in using multiple monitors and navigating various applications.

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

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

• Competence in logging into secure systems including VPN and EHR portals.

• Adherence to computer security practices, such as creating strong passwords and identifying suspicious emails or links.

• Ability to troubleshoot common technical issues.

• Preferred: Certified Case Manager (CCM) credential.

• Preferred: Residence in a compact state.

• Preferred: Over 3 years of experience with Microsoft Office Suite.

• Preferred: Experience in case management within an integrated model.

• Preferred: Experience in discharge planning.

• Preferred: Experience in managed care.

• Preferred: Bachelor of Science in Nursing (BSN).

🏝️ Benefits

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

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Options for retirement savings.

• Wellness programs.

• Additional resources to support physical, emotional, and financial wellness.

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

• Company-covered expenses for obtaining multiple state RN licensure post-hire.