Case Manager, Registered Nurse

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

📋 Description

• Evaluate, strategize, implement, and coordinate case management tasks through telephonic communication and/or in-person interactions.

• Assess members’ medical requirements to promote overall wellness.

• Jointly create proactive strategies to enhance both short-term and long-term health outcomes.

• Analyze assessments, claims, clinical tools, information, and available benefits.

• Partner with and refer members to programs provided by the plan sponsor.

• Utilize clinical judgment to mitigate risk factors while addressing complex health issues and social determinants.

• Employ case management processes in adherence to regulatory guidelines and company policies and procedures.

• Conduct interviews with members to optimize engagement and ascertain health status and requirements.

• Work Monday through Friday during scheduled 8-hour shifts from 8:30 a.m. to 5:00 p.m. local time.

• Potentially offer weekend and holiday on-call support on a voluntary basis.

• Travel less than 5% for on-site meetings, training sessions, system updates, or licensure obligations.

⛳️ Requirements

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

• Capability to use a compact RN license without restrictions if residing within the Nurse Licensure Compact jurisdiction.

• Openness and readiness to acquire additional state licenses upon employment.

• A minimum of 3 years of acute care clinical experience as an RN.

• Proficiency in operating a computer station with multiple screens, running several programs concurrently, and sitting for extended durations.

• A private designated workspace that is free from distractions and equipped with high-speed internet.

• An Associate's Degree in Nursing is required.

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

• Minimum internet speed of 25 Mbps for downloads and 3 Mbps for uploads is required.

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

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

• Familiarity with Microsoft Office 365 or similar tools like Google Workspace.

• Competence in using email, calendar invites, Teams messaging, and virtual meeting platforms.

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

• Skills in managing strong passwords and identifying suspicious emails or links.

• Ability to troubleshoot common technical issues and reach out to IT support when necessary.

• Preferred: Compact RN licensure.

• Preferred: At least 1 year of case management experience.

• Preferred: Certified Case Manager (CCM) certification.

• Preferred: Proficiency in Microsoft PowerPoint, Excel, and Word.

• Preferred: Strong verbal communication skills over the phone.

• Preferred: Over 1 year of experience using computers and multiple monitors while engaging in telephone conversations.

🏝️ 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 initiatives.

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

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

• Additional state licenses covered by the company.