Case Manager, Registered Nurse

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

📋 Description

• Conduct assessments of members either through phone calls or in-person meetings.

• Strategically plan, implement, and coordinate activities related to case management.

• Analyze members’ medical needs to promote overall well-being.

• Work collaboratively to create proactive strategies aimed at enhancing both short- and long-term outcomes.

• Review clinical tools, assessments, claims, and various data to assess member needs and available benefits.

• Partner with and direct members to programs provided by plan sponsors.

• Utilize clinical judgment to mitigate risk factors and tackle complex health issues along with social determinants.

• Implement case management processes in accordance with regulatory guidelines and company policies.

• Employ interviewing techniques to optimize member engagement and ascertain health status and needs.

• Available to work Monday through Friday during designated 8-hour shifts between 8:30 a.m. and 5:00 p.m. in the employee’s time zone.

• May work weekends and holidays on an on-call, voluntary basis.

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

⛳️ Requirements

• Must possess an active, current, and unrestricted RN license in the state of residence.

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

• Willingness and capability to acquire additional state licenses upon hiring.

• Minimum of 3 years of acute care clinical experience as a registered nurse.

• Proficient in using a computer station with multiple screens and capable of running various programs simultaneously.

• Ability to remain seated for prolonged periods.

• Designated private workspace that is free from distractions.

• Access to high-speed internet.

• Associate Degree in Nursing is mandatory.

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

• Minimum internet speed of 25 Mbps for downloading and 3 Mbps for uploading.

• Quiet, secure, private, and HIPAA-compliant home workspace.

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

• Experience with multiple monitors and various applications.

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

• Familiarity with Microsoft Office 365 applications or similar tools such as Google Workspace.

• Ability to access secure systems, including VPN and EHR portals.

• Skills in adhering to computer security practices, managing strong passwords, and identifying suspicious emails or links.

• Ability to independently resolve common technical problems.

• Preferred: Compact RN licensure.

• Preferred: Over 1 year of case management experience.

• Preferred: Certified Case Manager (CCM) certification.

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

• Preferred: Strong telephonic communication abilities.

• Preferred: Over 1 year of experience utilizing computers and navigating multiple monitors while engaged in phone 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 programs.

• Additional resources to support physical, emotional, and financial health.

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

• Additional state licenses funded by the company.