Case Manager, Registered Nurse – New York License

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

📋 Description

• Perform thorough evaluations of members’ medical, behavioral health, and social determinants of health needs.

• Dedicate 50–75% of your day to engaging with members via telephone and coordinating their care.

• Gather clinical information and create personalized care plans in collaboration with members.

• Deliver evidence-based education and support for disease management.

• Include the relevant members of the interdisciplinary care team in the process.

• Ensure seamless healthcare experiences through effective care coordination.

• Accurately document care management activities in members’ electronic health records in a timely manner.

• Work alongside the Interdisciplinary Care Team to identify and address barriers to care, maintaining stable health conditions.

• Connect members with health plan benefits, community resources, and available support services.

• Adhere to regulatory requirements within designated timelines.

• Assist Care Team members with clinical decision-making and provide guidance.

• Engage in special projects, process improvement initiatives, and mentor new team members as required.

• Educate and support members and their families in managing chronic conditions and navigating healthcare.

• Advocate for essential services and monitor the progress of members.

⛳️ Requirements

• Must possess active and unrestricted Registered Nurse (RN) licensure in New York, or compact licensure in your state of residence.

• Required: Associate’s of Science in Nursing (ASN) degree and relevant experience in a healthcare-related field.

• Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams.

• Must have access to a private, dedicated workspace at home.

• Capability to work independently from home while collaborating virtually.

• A minimum of 3+ years of nursing experience is required.

• At least 2+ years of case management, discharge planning, and/or home healthcare coordination experience is necessary.

• Ability to meet performance and productivity metrics, including call volume, member engagement, and regulatory standards.

• Experience or willingness to understand care management within Medicare and Medicaid managed care.

• Familiarity with community resources and services is essential.

• Proficient in using healthcare technology tools.

• Strong verbal and written communication skills.

• Excellent customer service and engagement abilities are a must.

• BSN is preferred.

• Preferred experience includes working with Medicare and/or Medicaid members, social determinants of health needs, chronic medical conditions, behavioral health, health-related assessments, and care planning.

• Bilingual skills, particularly in English and Spanish, are preferred.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

• Eligibility for CVS Health bonus, commission, or short-term incentive programs.