Case Manager, Registered Nurse

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

📋 Description

• Evaluate, plan, facilitate, coordinate, assess, and advocate for services that meet the comprehensive health needs of members and their families.

• Serve as a point of contact among members, clients, families, employers, providers, insurers, and healthcare professionals.

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

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

• Engage with members via telephone or in person, which may include visits to homes, worksites, or healthcare facilities.

• Assess medical and vocational statuses and create care plans aimed at maximizing wellness, medical outcomes, functionality, benefits eligibility, and return to work opportunities.

• Liaise with medical providers, attorneys, employers, and insurance carriers.

• Prepare necessary documentation for case work.

• Collaborate with internal multidisciplinary teams.

• Communicate with treating physicians or specialists regarding care and treatment plans.

• Provide educational resources and preventive information.

• Implement rehabilitation service laws, regulations, insurer guidelines, and referral-source requirements.

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

• Monitor progress toward achieving desired outcomes through ongoing assessment and evaluation.

• Create proactive strategies to enhance short- and long-term outcomes and overall wellness.

⛳️ Requirements

• Possession of an active and unrestricted Compact Registered Nurse (RN) License in Alabama, Arkansas, Maryland, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, Georgia, or Florida.

• A minimum of 3 years of preferred clinical practical experience in 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.

• Proficient in Microsoft Word, Excel, Outlook, PowerPoint, and other proprietary applications.

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

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

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

• A Bachelor's Degree in Nursing is preferred.

• Must have a direct/hardwired internet connection to a modem/router within 7 feet of the computer, with minimum speeds of 25 Mbps download and 3 Mbps upload; WiFi and satellite internet connections are not acceptable.

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

• Must reside in the state and city where currently living.

• Capability to meet required internet speeds and comply with Work From Home regulations.

• Ability to set up and utilize multiple monitors and navigate various applications.

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

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

• Ability to access secure systems such as VPN and EHR portals, maintain password security, and recognize suspicious emails or links.

• Competence in resolving common technical issues independently.

• Willingness to learn new skills.

• Spanish bilingual ability, Certified Case Manager credential, and national professional certifications (such as CRC, CDMS, CRRN, COHN, or CCM) are preferred.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• Eligibility for CVS Health bonus, commission, or short-term incentive programs.

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