Case Manager, Registered Nurse

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

📋 Description

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

• Serve as an advocate for patients, ensuring effective communication, resource management, and ongoing progress tracking.

• Act as a liaison between members/clients/families, employers, providers, insurance companies, and healthcare staff.

• Implement and manage case management activities for catastrophic cases and members/clients with chronic illnesses across the entire 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, work sites, or physician offices.

• Assess the medical and vocational status of injured, acutely ill, or chronically ill members/clients.

• Create care plans aimed at optimizing wellness, improving medical outcomes, facilitating return to work, and achieving functional goals.

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

• Document all required casework activities accurately.

• Collaborate with internal multidisciplinary teams.

• Reach out to treating physicians or specialists concerning treatment plans and care courses.

• Provide educational resources and prevention information.

• Apply relevant laws, regulations, insurance carrier guidelines, and referral-source requirements.

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

• Track progress toward desired outcomes through assessment and evaluation.

• Formulate proactive strategies to enhance both short- and long-term outcomes and overall wellness.

⛳️ Requirements

• The candidate should preferably reside in MA.

• Must hold active and unrestricted RN licensure in MA.

• A minimum of 3 years of clinical practical experience is preferred, including areas such as diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac, or Home Health with Medicare members.

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

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

• Must be capable of working in a fast-paced, high-volume environment while effectively managing time and prioritizing tasks.

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

• Must possess a working knowledge of problem-solving and decision-making skills.

• Familiarity with medical terminology is essential.

• Digital literacy skills are required.

• Ability to engage tactfully with customers and the community is necessary.

• Must handle sensitive information in an ethical and responsible manner.

• Capability to evaluate the relative costs and benefits of potential actions is crucial.

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

• Excellent analytical and problem-solving abilities are preferred.

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

• Proficiency in Spanish is preferred.

• An Associate's Degree in Nursing is required.

• A Bachelor's Degree in Nursing is preferred.

• Must have active and unrestricted Compact Registered Nurse (RN) Licensure in the state of residence (MA).

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

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

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

• Must supply own workspace furniture.

• Ability to utilize multiple monitors and applications simultaneously is necessary.

• Must be able to communicate via email, calendar invites, Teams messaging, and virtual meetings.

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

• Ability to log in to secure systems such as VPN and EHR portals, manage strong passwords, and identify suspicious emails or links is required.

• Must be capable of independently resolving common technical issues.

• Willingness to learn new skills as the workplace evolves is essential.

🏝️ Benefits

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

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

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