Case Manager – Registered Nurse

This is a fully remote position, open to applicants in Alabama, +39 more states.

📋 Description

• Evaluate, strategize, implement, and coordinate case management activities both over the phone and in-person.

• Assess members' medical requirements to promote overall wellness.

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

• Analyze clinical tools, data, prior claims, benefit eligibility, and member conditions.

• Support transitions to Aetna programs and plans.

• Utilize clinical judgment to mitigate risk factors and tackle health and social obstacles.

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

• Refer members to clinical resources when necessary.

• Collaborate with supervisors and colleagues to navigate barriers.

• Present cases at multidisciplinary case conferences.

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

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

• Work Monday through Friday, from 9:00 a.m. to 5:30 p.m. in your time zone, with occasional evening, weekend, and holiday shifts.

• No travel is required.

⛳️ Requirements

• Current RN licensure in the state of residence.

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

• Willingness and capability to acquire multiple state RN licensure post-hire if selected.

• Associate Degree in Nursing.

• 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.

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

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

• Proficient in using multiple monitors and navigating various applications.

• Competent in using digital communication channels such as email, calendar invites, Teams messaging, and virtual meetings.

• Experience with Microsoft Office 365 applications (Teams, Outlook, Word, Excel, PowerPoint) or equivalent Google Workspace tools.

• Capability to access secure systems like VPN and EHR portals.

• Ability to adhere to computer security protocols, manage strong passwords, and identify suspicious emails or links.

• Skills to troubleshoot common technical issues independently.

• Preferred: Certified Case Manager (CCM) certification.

• 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: managed care experience.

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

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

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

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