Case Manager, Registered Nurse

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

📋 Description

• Evaluate the health status of members and their care coordination needs.

• Perform inpatient reviews and plan for discharges.

• Create, implement, monitor, and assess case management plans.

• Collaborate with the Medical Director as needed and close cases once discharge criteria are satisfied.

• Utilize data-driven techniques to identify members and develop tailored case management programs or referrals.

• Conduct thorough clinical assessments.

• Assess needs and formulate adaptable strategies based on member requirements, benefit plans, or external services.

• Advocate for patients within the framework of their current healthcare coverage.

• Encourage high-quality, cost-effective outcomes and recommend improvements for program or operational efficiencies.

• Identify and escalate any quality-of-care concerns.

• Deliver an exceptional level of customer service.

• Evaluate health literacy, technological capabilities, and readiness for change.

• Employ influencing and motivational interviewing techniques to enhance member engagement.

• Offer coaching, information, education, and support for independent medical and healthy lifestyle choices.

• Operate in a queue-type environment during Monday to Friday hours, with rotational evening, weekend, and holiday shifts.

⛳️ Requirements

• Active and unrestricted RN license in the state of residence.

• Capability to acquire multi-state licensure upon hiring.

• Over 3 years of acute care experience as an RN.

• More than 3 years of experience with Microsoft Suite products.

• Strong problem-solving abilities and clinical decision-making skills.

• Proficient in managing sensitive information with confidentiality and professionalism.

• Excellent communication and relationship-building capabilities.

• Ability to work effectively with diverse patient populations and healthcare teams.

• Minimum of an Associate Degree in Nursing is required.

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

• Minimum internet speed of 25 Mbps download and 3 Mbps upload.

• WiFi and satellite internet connections are not allowed.

• A quiet, secure, and private home workspace compliant with CVS Health and HIPAA standards.

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

• Ability to use multiple monitors and applications simultaneously.

• Proficient in communication via email, calendar invitations, Teams messaging, and virtual meetings.

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

• Ability to access secure systems such as VPN and EHR portals.

• Familiarity with computer security practices, including strong password usage and recognizing suspicious emails or links.

• Ability to independently resolve common technical issues.

• Willingness to learn new skills as the workplace evolves.

🏝️ Benefits

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

• 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.).