Case Manager, RN

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

📋 Description

• Perform telephonic evaluations of members’ medical, behavioral, and social needs.

• Create personalized care plans to enhance health outcomes and overall wellness.

• Recognize obstacles to care and execute strategies for risk reduction and member engagement.

• Facilitate care coordination among providers, programs, and community resources.

• Analyze clinical data, claims history, and benefit eligibility.

• Employ motivational interviewing techniques and clinical judgment to engage members and assist in achieving their goals.

• Collaborate with multidisciplinary teams on intricate cases.

• Ensure adherence to regulatory mandates and company case management protocols.

• Work Monday through Friday on a standard schedule from 8:00 AM to 4:30 PM local time.

• Provide occasional support for late-shift rotations and holiday on-call duties.

⛳️ Requirements

• Active, unrestricted RN license in the state where you reside.

• Capability to obtain multi-state/compact licensure.

• Over 3 years of clinical nursing experience.

• At least 1 year of experience with Microsoft Office (Outlook, Word, Excel).

• Availability to work Monday through Friday, with start times as early as 8:00 AM in your local time zone.

• Willingness to participate in rotating late shifts until 8:00 PM EST and holiday on-call coverage as required.

• An Associate Degree in Nursing is mandatory.

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

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

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

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

• Proficient in setting up and utilizing multiple monitors and navigating various applications simultaneously.

• Capability to utilize email, calendar invites, Teams messaging, and virtual meetings.

• Familiarity with Microsoft Office 365 applications or comparable Google Workspace tools.

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

• Competence in independently resolving common technical issues.

• A BSN degree is preferred.

• A compact RN license is preferred.

• Experience in Case Management is preferred.

• Case Manager Certification (CCM or equivalent) is preferred.

🏝️ Benefits

• Company-sponsored ability to obtain multi-state/compact licensure.

• Opportunities for multi-state licensure funded by the company.

• No travel is necessary.

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

• Medical, dental, and vision insurance coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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