Case Manager, RN

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

📋 Description

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

• Perform inpatient reviews and facilitate discharge planning.

• Create, implement, monitor, and assess case management plans.

• Engage the Medical Director as necessary and close cases upon meeting discharge criteria.

• Utilize data-driven methods to identify members for tailored case management programs or alternative healthcare referrals.

• Conduct thorough clinical assessments.

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

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

• Foster quality, cost-effective outcomes and recommend enhancements for program or operational efficiencies.

• Identify and escalate quality-of-care concerns.

• Deliver exceptional customer service.

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

• Employ influencing techniques and motivational interviewing to engage members and encourage lifestyle or behavioral changes.

• Offer coaching, information, education, and support to empower members in making independent medical and healthy lifestyle choices.

⛳️ Requirements

• Must possess an active, current, and unrestricted RN license in the state of residence.

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

• A minimum of 3 years of acute care experience as a registered nurse.

• Availability to work Monday through Friday, from 8:00am to 4:30pm in the local time zone, with the potential for an occasional late shift rotation from 11:00am to 8:00pm EST once per quarter.

• An Associate Degree is required.

• Compact RN License or multistate licensure is preferred.

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

• Experience in Managed Care is preferred.

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

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

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

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

• WiFi and satellite internet connections are not acceptable.

• A quiet, secure, and private designated home workspace compliant with CVS Health and HIPAA regulations is necessary.

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

• Workspace furniture must be provided by the employee.

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

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

• Familiarity with Microsoft Office 365 applications or similar Google Workspace applications is needed.

• Ability to access secure systems such as VPN and EHR portals is required.

• Must adhere to computer security and password protocols and recognize suspicious emails or links.

• Competence to troubleshoot common technical issues independently is essential.

🏝️ Benefits

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

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Various resources to support physical, emotional, and financial well-being.

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

• Additional state licenses will be paid for by the company.