Case Manager, RN

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

📋 Description

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

• Perform inpatient assessments and plan for discharges.

• Design, execute, oversee, and assess case management strategies.

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

• Employ data-driven techniques to pinpoint members for tailored case management initiatives or alternative healthcare referrals.

• Conduct thorough clinical evaluations.

• Assess member needs and formulate adaptable strategies based on benefit programs or external services.

• Advocate for patients within the framework of their existing healthcare coverage.

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

• Identify and report quality-of-care concerns through established protocols.

• Deliver exceptional customer service.

• Evaluate health literacy, technological capabilities, and readiness to change.

• Utilize persuasive and motivational interviewing techniques to engage members and encourage lifestyle or behavioral modifications.

• Offer coaching, resources, education, and support to empower independent medical decisions and healthy lifestyle choices.

• Collaborate with members, healthcare resources, and Medical Directors through assessment, planning, facilitation, and advocacy.

⛳️ Requirements

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

• Willingness to obtain additional state licenses upon hiring.

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

• Availability to work Monday through Friday from 8:00 AM to 4:30 PM in the local time zone, with occasional late shift rotations of 11:00 AM to 8:00 PM EST once per quarter.

• An Associate Degree is required.

• Compact RN License or multi-state licensure is preferred.

• Certified Case Manager (CCM) designation is preferred.

• Experience in Managed Care is preferred.

• Hospital experience in ICU, CCU, Step Down, ER, or OR is preferred.

• Preference for telephonic case management and/or related telephonic experience.

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

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

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

• Must be able to work within the state and city of residence.

• Capability to utilize multiple monitors and manage various applications simultaneously.

• Proficiency in communicating via email, calendar invites, Teams messaging, and virtual meetings.

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

• Ability to access secure systems like VPN and EHR portals while adhering to security protocols.

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

• Willingness to learn new workplace skills.

🏝️ 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 supporting physical, emotional, and financial well-being.

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

• Company-paid additional state licenses upon hiring.