Case Manager, Registered Nurse

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

📋 Description

• Employ a collaborative approach involving assessment, planning, facilitation, and advocacy for available options and services.

• Evaluate the health status and care coordination requirements of members.

• Perform inpatient reviews and discharge planning.

• Design, execute, monitor, and assess case management plans.

• Engage the Medical Director as necessary and finalize cases once discharge criteria are fulfilled.

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

• Conduct thorough clinical assessments.

• Analyze needs and create adaptable strategies based on member requirements, benefit plans, or external services/programs.

• Advocate for patients within the scope of their healthcare coverage.

• Encourage quality, cost-effective outcomes and recommend enhancements to program and operational efficiency.

• Recognize and escalate quality-of-care concerns through established procedures.

• Deliver exceptional customer service.

• Assess members’ health literacy, technological capabilities, and willingness to change.

• Utilize influencing and motivational interviewing techniques to enhance member engagement and support lifestyle or behavioral modifications.

• Offer coaching, information, education, and assistance to empower members in making independent medical and healthy lifestyle decisions.

• Operate in a queue-based environment.

• Handle multiple priorities while showcasing organizational, time management, decision-making, and teamwork capabilities.

⛳️ Requirements

• Possession of an active and unrestricted RN license in the state of residence.

• Capability to obtain multi-state licensure upon hiring.

• Minimum of 3 years of acute care experience as a Registered Nurse.

• At least 3 years of experience with Microsoft Suite products.

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

• Proficiency in managing sensitive information with professionalism and confidentiality.

• Excellent communication and relationship-building abilities.

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

• An Associate Degree in Nursing is required.

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

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

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

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

• Capability to furnish own workspace furniture.

• Proficiency in using multiple monitors and navigating several applications at once.

• Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings.

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

• Capability to log in to secure systems such as VPN and EHR portals.

• Knowledge of creating strong passwords and identifying suspicious emails or links.

• Ability to independently resolve common technical issues.

• Willingness to learn new skills as the workplace environment 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 promoting physical, emotional, and financial well-being.

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

• Opportunity to work from home.