Case Manager, Registered Nurse

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

📋 Description

• Oversee and facilitate thorough care for individuals.

• Evaluate member requirements and create tailored care plans.

• Coordinate services among various healthcare providers.

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

• Act as a liaison among members, families, employers, providers, insurance companies, and healthcare professionals.

• Manage case activities for catastrophic cases and chronically ill members throughout their care continuum.

• Conduct telephonic and in-person engagements, which may include home, worksite, or physician office visits.

• Assess medical and/or vocational conditions and support management of health, wellness, medical outcomes, return to work, and benefits eligibility.

• Communicate with members and stakeholders, including healthcare providers, attorneys, employers, and insurance carriers.

• Prepare necessary case documentation.

• Collaborate with internal multidisciplinary teams.

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

• Provide education and preventive information.

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

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

• Monitor member progress towards achieving desired outcomes.

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

⛳️ Requirements

• Candidate preferably resides in Michigan.

• Active and unrestricted RN licensure in Michigan.

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

• 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.

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

• Working knowledge of medical terminology and digital literacy.

• Capability to thrive in a fast-paced, high-volume environment.

• Effective time management and prioritization skills.

• Ability to handle sensitive information with ethical considerations and responsibility.

• Associate's Degree in Nursing (REQUIRED).

• Active and unrestricted Compact Registered Nurse (RN) Licensure in the state of residence (MI).

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

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

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

• Proficiency in setting up and using multiple monitors and navigating various applications.

• Competency in utilizing digital communication tools, Microsoft Office 365 or Google Workspace.

• Capability to access secure systems such as VPN and EHR portals, adhering to security protocols.

• Ability to troubleshoot common technical issues.

• Willingness to learn new skills.

• Preferred: national professional certification (CRC, CDMS, CRRN, COHN, or CCM).

• Preferred: bilingual in Spanish.

• Bachelor's Degree in Nursing (PREFERRED).

🏝️ Benefits

• Comprehensive medical, dental, and vision insurance.

• 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.).

• Eligibility for CVS Health bonus, commission, or short-term incentive programs.