Case Manager, Registered Nurse

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

📋 Description

• Conduct assessments of members either via telephone or in-person.

• Strategize, execute, and oversee case management initiatives.

• Analyze members’ medical requirements to promote overall health.

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

• Examine clinical tools, information, data, previous claims, benefit eligibility, and member requirements.

• Assist members in transitioning to Aetna programs and plans.

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

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

• Identify the necessity for referrals to clinical resources.

• Collaborate with supervisors and others to navigate obstacles.

• Present cases during multidisciplinary case conferences.

• Employ case management methodologies in adherence to regulatory and company standards.

• Conduct interviews to engage members and evaluate their health status and requirements.

⛳️ Requirements

• Current RN licensure in the state of residence.

• Minimum of 2 years of clinical experience as a Registered Nurse.

• All clinical experience is considered, including but not limited to Emergency Department, Home Health, Hospice, Operating Room, ICU, NICU, Telemetry, Medical/Surgical, Orthopedics, Long Term Care, and Infusion nursing.

• Multiple State RN licensure is appreciated but not mandatory; candidates must be willing and able to obtain multiple state RN licensure post-hire if selected.

• Associate’s Degree in Nursing is required.

• Certification as a Certified Case Manager (CCM) is preferred.

• Preference will be given to candidates residing in compact states.

• 3+ years of experience with the Microsoft Office Suite is preferred.

• Experience in case management within an integrated model is preferred.

• Discharge Planning experience is preferred.

• Managed care experience is preferred.

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

• A direct/hardwired internet connection to a modem/router within 7 feet of the computer is required.

• Minimum internet speeds of 25 Mbps download and 3 Mbps upload are required.

• WiFi and satellite internet connections are not permitted.

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

• Candidates must work within the state and city where they currently reside.

• Ability to utilize multiple monitors and applications simultaneously.

• Proficiency in using email, calendar invites, Teams messaging, and conducting virtual meetings.

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

• Capability to access secure systems such as VPN and EHR portals is necessary.

• Ability to adhere to computer, password, and email security protocols is essential.

• Capacity to independently troubleshoot common technical issues is required.

• Willingness to acquire new skills as the workplace evolves is necessary.

🏝️ Benefits

• CVS Health offers bonuses, commissions, or short-term incentive programs in addition to base salary.

• Comprehensive medical coverage.

• Dental insurance included.

• Vision insurance provided.

• Paid time off is offered.

• Retirement savings options available.

• Access to wellness programs.

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

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

• Company-paid expenses for obtaining multiple state RN licensure after hire, if necessary.