Case Manager, Registered Nurse

This is a fully remote position, open to applicants in Florida, +1 more state.

📋 Description

• Facilitate and coordinate comprehensive care for individuals by evaluating their needs, creating tailored care plans, and coordinating services among healthcare providers.

• Advocate for patients, ensuring effective communication, optimal resource utilization, and ongoing progress monitoring.

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

• Implement and manage case management activities for catastrophic cases and chronically ill members across their care continuum.

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

• Engage with members/clients via phone or in person, which may include visits to homes, worksites, or physician offices.

• Assess medical and/or vocational status and formulate care plans aimed at enhancing wellness, medical outcomes, and return to work capabilities.

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

• Prepare necessary case work documentation.

• Collaborate with internal multidisciplinary teams.

• Contact treating physicians or specialists concerning care and treatment.

• Provide educational and preventive information.

• Apply relevant rehabilitation-service laws, regulations, and insurance-carrier guidelines.

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

• Adhere to regulatory and company policies and procedures for case management.

• Develop proactive strategies and monitor progress towards achieving desired outcomes.

• Work remotely from a designated home workspace while assisting members in Florida or Ohio.

⛳️ Requirements

• Candidates must reside in either Florida or Ohio.

• Must possess an active and unrestricted Compact Registered Nurse (RN) License in the state of residence (FL or OH).

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

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

• Ability to thrive in a fast-paced, high-volume setting and utilize time management and prioritization skills.

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

• Understanding of problem-solving and decision-making processes.

• Familiarity with medical terminology.

• Working knowledge of digital literacy skills.

• Capability to interact tactfully with customers and the community.

• Ability to manage sensitive information ethically and responsibly.

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

• National professional certification (CRC, CDMS, CRRN, COHN, or CCM) is preferred.

• Excellent analytical and problem-solving skills are preferred.

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

• Bilingual Spanish is preferred.

• An Associate's Degree in Nursing is REQUIRED.

• A Bachelor's Degree in Nursing is PREFERRED.

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

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

• Ability to work within the state and city of current residence.

• Must provide own workspace furniture.

• Capability to set up and use multiple monitors and navigate various applications.

• Proficiency in using digital communication tools such as email, calendar invites, Teams messaging, and virtual meetings.

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

• Ability to log into secure systems such as VPN and EHR portals, maintain security practices, and identify suspicious emails or links.

• Proficiency in troubleshooting common technical issues and contacting IT when necessary.

• Willingness to learn new skills.

🏝️ Benefits

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

• Medical coverage.

• Dental coverage.

• Vision 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.