Case Manager, RN

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

📋 Description

• Evaluate the health status of members and their needs for care coordination.

• Perform inpatient reviews and oversee discharge planning.

• Create, execute, monitor, and assess case management strategies.

• Consult with the Medical Director when necessary.

• Close cases when members fulfill discharge criteria.

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

• Carry out thorough clinical assessments.

• Analyze needs and devise strategies based on members' requirements, benefit plans, and external programs or services.

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

• Foster quality, cost-effective results and propose enhancements for programs or operations.

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

• Deliver exceptional customer service.

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

• Employ motivational interviewing and influence techniques to engage members and encourage lifestyle or behavior modifications.

• Offer coaching, information, education, and support to enable independent medical decisions and healthy lifestyle choices.

• Collaborate with members, healthcare resources, and the Medical Director as appropriate.

⛳️ Requirements

• An active, current, and unrestricted RN license in the state of residence.

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

• A minimum of 3 years of acute care experience as an RN.

• Willingness and ability to work Monday through Friday, from 8:00 am to 4:30 pm in the local time zone, with occasional late shifts of 11:00 am to 8:00 pm EST once per quarter.

• An Associate Degree is required.

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

• Certification as a Case Manager (CCM) is preferred.

• Experience in Managed Care is preferred.

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

• Experience in telephonic case management and/or telephonic roles is preferred.

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

• Minimum internet speed of 25 Mbps for downloads and 3 Mbps for uploads.

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

• Must work within the state and city of current residence.

• Ability to provide personal workspace furniture.

• Capability to use multiple monitors and navigate various applications.

• Proficiency in using email, calendar invites, Teams, virtual meetings, and Microsoft Office 365 or similar Google Workspace applications.

• Ability to access secure systems such as VPN and EHR portals, maintain strong passwords, and identify suspicious emails or links.

• Competence in troubleshooting common technical issues independently.

🏝️ 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.

• Options for retirement savings.

• Wellness programs.

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

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

• Company-paid additional state licenses obtained after hiring.

• Flexible work-from-home arrangement.