Case Manager, Registered Nurse – Medicare

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

📋 Description

• Ensure the effective delivery of relevant benefits and healthcare information to assess eligibility for benefits.

• Encourage participation in wellness initiatives.

• Create, execute, and assist in health strategies, policies, tactics, and programs.

• Aid in the provision of benefits, member wellness, and prompt return to work.

• Conduct assessments, planning, facilitation, care coordination, evaluation, and advocacy.

• Coordinate options and services that address the comprehensive health needs of members and their families.

• Collaborate with members, healthcare providers, and community organizations.

• Address healthcare and social determinant needs of members.

• Promote outcomes that are both high-quality and cost-effective.

• Operate within a member-focused, team-oriented, community-based care management framework.

⛳️ Requirements

• Possession of an active and unrestricted RN Compact license.

• A minimum of 3+ years of clinical practical experience is preferred, particularly in areas such as Diabetes, CHF, CKD, post-acute care, hospice, palliative care, or cardiac care involving Medicare members.

• At least 2+ years of experience in Case Management, discharge planning, and/or home health care coordination.

• Strong analytical and problem-solving abilities.

• Excellent communication, organizational, and interpersonal skills.

• Capacity to work independently, including the possibility of remote work.

• Proficient in MS Word, Excel, Outlook, PowerPoint, and other proprietary applications.

• Competent computer skills, including the ability to navigate multiple systems and perform keyboarding tasks efficiently.

• Willingness and capability to acquire multi-state RN licenses if required.

• Certification as a Case Manager is preferred.

• Additional national professional certifications (such as CRC, CDMS, CRRN, COHN, or CCM) are preferred but not mandatory.

• An Associate degree or Nursing diploma is required.

• A Bachelor’s degree is preferred.

🏝️ Benefits

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

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• The company will assist in obtaining multi-state RN licenses if necessary.