Case Manager – Registered Nurse

This is a fully remote position, open to applicants in Alabama, +6 more states.

📋 Description

• Conduct assessments, planning, facilitation, care coordination, evaluation, and advocacy to address the comprehensive health needs of members and their families.

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

• Manage case coordination for catastrophic cases and chronically ill members throughout the continuum of care.

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

• Engage with members via telephone or in-person interactions, which may include visits to homes, worksites, or physician offices.

• Evaluate medical and/or vocational status and create plans of care to enhance wellness and outcomes.

• Facilitate a timely return to work or optimal functioning and assess benefit eligibility when applicable.

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

• Prepare necessary case-work documentation.

• Collaborate with internal multidisciplinary teams.

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

• Provide educational resources and prevention information.

• Adhere to applicable laws, regulations, insurance carrier instructions, and company policies.

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

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

• Facilitate condition management, wellness, medical outcomes, and a return to baseline or work.

⛳️ Requirements

• Active and unrestricted Compact Registered Nurse (RN) Licensure in Alabama, Arkansas, Maryland, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, Georgia, or Florida.

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

• Capable of thriving in a fast-paced, high-volume environment and utilizing time-management and prioritization skills.

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

• An Associate's Degree in Nursing or Nursing Diploma is REQUIRED.

• Comfortable setting up and utilizing multiple monitors while navigating various applications.

• Proficient in communication through email, calendar invites, Teams messaging, and virtual meetings.

• Experience with Microsoft Office 365 or similar tools, such as Google Workspace.

• Ability to access secure systems such as VPN and EHR portals, manage strong passwords, and identify suspicious emails or links.

• Capable of independently resolving common technical issues.

• Must have a direct/hardwired internet connection with minimum speeds of 25 Mbps download and 3 Mbps upload.

• A quiet, secure, private, and distraction-free home workspace that complies with CVS Health and HIPAA guidelines.

• Must reside and work within the state and city where currently living.

• Spanish bilingual ability, Certified Case Manager, national professional certification, and Bachelor's Degree in Nursing are preferred.

🏝️ Benefits

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

• 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, including keyboard, monitor, computer, and headset.