Case Manager, Registered Nurse

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

📋 Description

• Facilitate and coordinate comprehensive care for individuals by assessing their needs, creating personalized care plans, and managing services among healthcare providers.

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

• Act as a liaison among members, clients, families, employers, providers, insurers, and healthcare personnel.

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

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

• Engage with members and clients either via telephone or in person, including at their homes, workplaces, or physician offices.

• Evaluate medical and vocational status, developing care plans to enhance wellness, outcomes, functionality, and facilitate return to work.

• Maintain communication with members, clients, and stakeholders such as providers, attorneys, employers, and insurance carriers.

• Prepare necessary case documentation.

• Collaborate with internal multidisciplinary teams.

• Contact treating physicians or specialists regarding patient care and treatment.

• Provide educational resources and preventative information.

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

• Assess needs and eligibility for benefit plans utilizing clinical tools and data.

• Follow established case management processes and adhere to regulatory and company policies.

• Create proactive action plans aimed at improving both short- and long-term outcomes.

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

⛳️ Requirements

• Ideal candidate should reside in New York.

• Must possess active and unrestricted RN licensure in New York.

• 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 healthcare coordination is necessary.

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

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

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

• Knowledge of problem-solving, decision-making, medical terminology, and digital literacy.

• Capacity to interact tactfully with customers and the community.

• Ability to ethically and responsibly handle sensitive information.

• Skill in assessing the relative costs and benefits of various actions.

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

• Excellent analytical and problem-solving abilities are preferred.

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

• Bilingual 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 (FL or OH).

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

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

• Must work in the state and city where currently residing.

• Workspace furniture, such as a desk or standing desk, must be provided by the candidate.

• Must utilize multiple monitors and navigate various applications.

• Proficiency in using email, calendar invites, Teams messaging, and virtual meetings is required.

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

• Ability to log into secure systems such as VPN and EHR portals, maintain computer security, manage strong passwords, and recognize suspicious emails or links.

• Capability to troubleshoot common technical issues independently.

• Willingness to learn new workplace skills is important.

🏝️ Benefits

• Comprehensive medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

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

• Company-provided work equipment, including a keyboard, monitor, computer, and headset.

• Remote work arrangement.

• Company-provided additional benefits information during the application process.