Case Manager, Registered Nurse

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

📋 Description

• Facilitate and coordinate comprehensive care for individuals by evaluating needs, creating customized care plans, and managing services among healthcare providers.

• Serve as an advocate for patients, ensuring effective communication, resource utilization, and ongoing monitoring of progress.

• Act as a liaison among members, clients, families, employers, providers, insurance companies, and healthcare personnel.

• Implement and oversee case management activities for catastrophic cases and chronically ill individuals throughout the continuum of care.

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

• Engage with members and clients through phone, in-person interactions, and potentially visit their homes, workplaces, or physician offices.

• Evaluate and analyze medical and vocational status to develop care plans.

• Promote condition management, wellness, medical outcomes, return-to-work initiatives, and optimal functioning.

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

• Prepare necessary case work documentation.

• Collaborate with internal multidisciplinary teams.

• Contact treating physicians or specialists regarding care and treatment options.

• Provide education and preventive information to clients.

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

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

• Follow case management processes, regulatory standards, and company policies.

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

⛳️ Requirements

• Active and unrestricted Compact Registered Nurse (RN) Licensure in your state of residence: PA, OH, FL, NJ, GA, NC, TX, or CT.

• Preferred 3+ years of clinical practical experience in areas such as diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac, or home health with Medicare members.

• Minimum of 2 years of experience in case management, discharge planning, and/or home health care coordination required.

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

• Capability to thrive in a fast-paced, high-volume work environment.

• Strong time management and prioritization abilities.

• Proficient computer skills, including navigating multiple systems and typing.

• Familiarity with problem-solving, decision-making, medical terminology, and digital literacy.

• Ability to interact tactfully with customers and the community.

• Capacity to handle sensitive information with ethical considerations.

• Competence in evaluating the relative costs and benefits of potential actions.

• Preferred national professional certification (CRC, CDMS, CRRN, COHN, or CCM).

• Excellent analytical and problem-solving skills are preferred.

• Strong communication, organizational, and interpersonal skills are preferred.

• Bilingual in Spanish is preferred.

• Associate's Degree in Nursing is required; Bachelor's Degree in Nursing is preferred.

• 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 are not permitted.

• A quiet, secure, private designated home work location compliant with CVS Health and HIPAA guidelines.

• Ability to provide your own workspace furniture.

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

• Proficient 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, follow computer security protocols, and recognize suspicious emails or links.

• Ability to troubleshoot common technical issues and contact IT support as needed.

• Willingness to learn new skills.

🏝️ Benefits

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

• Comprehensive medical coverage.

• Dental insurance.

• Vision insurance.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

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