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 meet the comprehensive health needs of members and their families.

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

• Execute and manage case management activities for catastrophic cases and members with chronic illnesses throughout the continuum of care.

• Coordinate referrals to consultants, home care visits, community resources, and alternative care levels.

• Engage with members via telephone, in person, and potentially in their homes, workplaces, or physician offices.

• Evaluate medical and/or vocational status and create care plans aimed at maximizing wellness, medical outcomes, functioning, and returning to work.

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

• Prepare necessary documentation for casework.

• Collaborate with internal multidisciplinary teams.

• Conduct outreach to treating physicians or specialists regarding care and treatment plans.

• Provide educational materials and prevention information.

• Adhere to laws, regulations, insurer guidelines, and referral-source requirements.

• Assess member needs and eligibility for benefit plans using clinical tools and data.

• Follow case management protocols, regulatory guidelines, and company policies.

• Create proactive action plans and monitor progress towards achieving desired outcomes.

• Facilitate condition management, wellness initiatives, timely return to baseline, optimal functionality, or return to work.

⛳️ Requirements

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

• Minimum of 3 years of preferred clinical practical experience 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.

• Proficiency in Microsoft Word, Excel, Outlook, and PowerPoint, as well as proprietary applications.

• Capability to thrive in a fast-paced, high-volume environment, utilizing time management and prioritization skills.

• Strong computer skills, including the ability to navigate multiple systems and proficient typing.

• Associate's Degree in Nursing or a Nursing Diploma (MANDATORY).

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

• Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings.

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

• Proficient in logging into secure systems such as VPN and EHR portals, managing strong passwords, and identifying suspicious emails or links.

• Capability to independently troubleshoot common technical issues.

• Direct/hardwired internet connection within 7 feet of the modem/router with a minimum of 25 Mbps download and 3 Mbps upload; WiFi and satellite internet are not allowed.

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

• Must reside and work within the state and city of current residence.

• Must provide personal workspace furniture for extended desk work.

• Must meet the required internet speeds and follow Work From Home guidelines if selected for the position.

🏝️ 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 (keyboard, monitor, computer, headset, etc.).