Case Manager, Registered Nurse

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

📋 Description

• Facilitate the assessment, planning, care coordination, evaluation, and advocacy for the comprehensive health needs of members and their families.

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

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

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

• Interact with members and clients via phone or in person, including at their homes, workplaces, or physicians’ offices as necessary.

• Assess and analyze medical and/or vocational statuses to create individualized care plans.

• Facilitate condition management, wellness initiatives, medical outcomes, eligibility assessments, and strategies for return to work or optimal functioning.

• Communicate with members and stakeholders about treatment plans and care courses.

• Prepare necessary case documentation.

• Collaborate with internal multidisciplinary teams.

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

• Provide educational resources and prevention information.

• Adhere to rehabilitation-services laws, regulations, and guidelines from insurance carriers.

• Evaluate member needs and benefit-plan eligibility using clinical tools and data.

• Monitor member progress towards desired outcomes through assessment and evaluation.

• Develop proactive action plans aimed at enhancing short- and long-term outcomes as well as overall wellness.

⛳️ Requirements

• Active and unrestricted Registered Nurse (RN) License in Illinois (IL).

• Associate's Degree or Nursing Diploma (REQUIRED).

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

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

• Strong analytical and problem-solving abilities.

• Willingness to occasionally travel within a specified geographic area for in-person case management tasks.

• Excellent communication, organizational, and interpersonal skills.

• Ability to work autonomously.

• Proficient in Microsoft Word, Excel, Outlook, PowerPoint, Microsoft Office 365, Teams, and/or similar applications.

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

• Willingness and capability to obtain multi-state Registered Nurse licenses if necessary.

• Certification as a Case Manager is preferred.

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

• Direct/hardwired internet connection to a modem/router within 7 feet of the computer.

• A minimum internet speed of 25 Mbps download and 3 Mbps upload.

• A quiet, secure, private, and HIPAA-compliant home workspace.

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

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

• Ability to access secure systems including VPN and EHR portals.

• Competence in managing strong passwords and identifying suspicious emails or links.

• Ability to troubleshoot common technical issues independently.

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

🏝️ Benefits

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

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Access to wellness programs.

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

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

• The company will facilitate the procurement of required multi-state RN licenses if necessary.

• Comprehensive benefits package for eligible full-time employees.