Case Manager, Registered Nurse

This is a fully remote position, open to applicants in Florida.

📋 Description

• Facilitate the provision of relevant benefits and healthcare information.

• Develop, implement, and support health strategies, policies, and programs.

• Assess, plan, facilitate, coordinate, evaluate, and advocate for the health needs of individuals and families.

• Serve as a liaison among members, families, employers, providers, insurers, and healthcare professionals.

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

• Provide referrals for consultants, home care visits, community resources, and alternative levels of care.

• Engage with members through phone calls or in-person visits, including at their homes, workplaces, or physician offices.

• Evaluate medical and vocational status and create care plans.

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

• Prepare necessary documentation for case work.

• Collaborate with internal multidisciplinary teams.

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

• Provide educational and preventive information.

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

• Testify as needed to support case work or reports.

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

• Monitor progress towards desired outcomes through assessment and evaluation.

• Facilitate management of conditions, wellness, medical outcomes, return to baseline, optimal function, or return to work.

⛳️ Requirements

• Must be a resident of Florida.

• Hold an active and unrestricted Compact Registered Nurse (RN) License in Florida.

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

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

• Required: Associate's Degree in Nursing with equivalent experience or Nursing Diploma.

• Preferred: Bachelor's Degree.

• Ability to occasionally travel within a specific geographic area for in-person case management activities.

• Excellent analytical and problem-solving abilities.

• Strong communication, organizational, and interpersonal skills.

• Capability to work independently.

• Proficiency in MS Word, Excel, Outlook, PowerPoint, and proprietary applications.

• Competent computer skills, including navigating multiple systems and keyboarding.

• Certified Case Manager certification preferred.

• Additional national professional certifications such as CRC, CDMS, CRRN, COHN, or CCM are advantageous.

• 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.

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

• Ability to use multiple monitors and navigate several applications simultaneously.

• Experience with Microsoft Office 365 or similar software is preferred.

• Ability to access secure systems such as VPN and EHR portals.

• Capability to independently resolve common technical issues.

• Willingness to learn new skills.

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

🏝️ Benefits

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

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

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