Case Manager, RN

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

📋 Description

• Conduct telephonic assessments, planning, implementation, and coordination of case management activities with members.

• Evaluate the medical requirements of members and promote overall wellness.

• Create proactive strategies to resolve issues and improve both short- and long-term outcomes.

• Utilize clinical tools and data analysis to assess member needs and eligibility for benefit plans.

• Facilitate integrative functions and ensure seamless transitions to Aetna programs and plans.

• Employ clinical judgment to mitigate risk factors and address complex health and social determinants.

• Assess co-morbidities, multiple diagnoses, functionality, work capacity, and any restrictions or limitations.

• Review previous claims for potential impacts on current case management and eligibility.

• Refer members to clinical resources as needed to evaluate functionality.

• Collaborate with supervisors and others to overcome obstacles and achieve goals.

• Present cases during multidisciplinary case conferences.

• Adhere to regulatory and company policies and procedures related to case management.

• Utilize interviewing techniques to engage members and assess their health status and needs.

• Work Monday through Friday from 9:00am to 5:30pm EST, with occasional evening and holiday shifts.

• Possible travel of 0–10%, including visits to the High Point office for customer meetings for those residing within 30 miles.

⛳️ Requirements

• Must reside in North Carolina.

• Must hold an active and unrestricted RN license in North Carolina.

• A minimum of 2 years of clinical experience as an RN.

• Associate's Degree in Nursing required.

• Multiple-state RN licensure is preferred but not mandatory; if selected, must be prepared to obtain it post-hire.

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

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

• WiFi and satellite internet connections are not accepted.

• A quiet, secure, and private home virtual work location compliant with CVS Health and HIPAA regulations is essential.

• Capability to use multiple monitors and navigate various applications simultaneously.

• Proficient in communicating through 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 such as VPN and EHR portals.

• Strong password management and the ability to identify suspicious emails or links are necessary.

• Ability to troubleshoot common technical issues independently.

• Willingness to learn new skills, including working with AI tools and products.

• Preferred: Certified Case Manager (CCM) certification.

• Preferred: 3+ years of experience with Microsoft Office Suite.

• Preferred: Experience in Case Management within an integrated model.

• Preferred: Experience in Discharge Planning.

• Preferred: Experience in Managed care.

• Preferred: BSN degree.

🏝️ Benefits

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

• Comprehensive medical coverage.

• Dental coverage included.

• Vision coverage available.

• Paid time off benefits.

• Retirement savings options provided.

• Access to wellness programs.

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

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

• Company will cover expenses for obtaining multiple-state RN licensure if acquired after hire.