Case Manager, Registered Nurse

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

📋 Description

• Oversee and deliver comprehensive care for individuals by evaluating needs, creating tailored care plans, and coordinating services among healthcare providers.

• Champion for patients, ensuring effective communication, resource allocation, and ongoing monitoring of their progress.

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

• Execute and manage case management activities for catastrophic cases and members/clients with chronic illnesses across the care continuum.

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

• Engage with members/clients through telephone or in-person interactions, which may include visits to homes, worksites, or physician offices.

• Evaluate medical and/or vocational status and devise care plans to enhance wellness, outcomes, functioning, and facilitate return to work.

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

• Prepare necessary case-work documentation.

• Collaborate with internal multidisciplinary teams.

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

• Provide educational resources and preventive information.

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

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

• Follow case-management protocols and comply with regulatory and company policies.

• Create proactive action plans and track progress toward achieving desired outcomes.

• Collaborate with members, providers, and community organizations to address healthcare and social determinant needs.

⛳️ Requirements

• Candidate should ideally reside in Illinois.

• Possess active and unrestricted RN licensure in Illinois.

• Associate's Degree in Nursing is 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 in diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac, or Home Health with Medicare members.

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

• Capable of working in a fast-paced, high-volume environment while utilizing time-management and prioritization skills.

• Strong computer skills, including the ability to navigate multiple systems and keyboard efficiently.

• Knowledgeable in problem-solving, decision-making, medical terminology, and digital literacy.

• Able to handle customer and community interactions with tact.

• Must manage sensitive information ethically and responsibly.

• National professional certification is preferred: 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.

• Maintain active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence (Illinois).

• Direct/hardwired internet connection to modem/router within 7 feet and minimum speeds of 25 Mbps download and 3 Mbps upload; WiFi and satellite internet are not permitted.

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

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

• Must provide personal workspace furniture.

• Ability to utilize multiple monitors and applications simultaneously.

• Capable of using email, calendar invites, Teams messaging, and virtual meetings effectively.

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

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

• Ability to troubleshoot common technical issues and reach out to IT as needed.

• Willingness to learn new skills.

🏝️ 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, and headset.