Registered Nurse Case Manager – Field

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

📋 Description

• Perform thorough telephonic and face-to-face evaluations of members' medical and behavioral health requirements.

• Create and implement personalized care plans that adhere to clinical and program standards.

• Coordinate and oversee the ongoing activities of care plans, making adjustments as needed to enhance outcomes.

• Collaborate in multidisciplinary reviews of care.

• Recognize and escalate any concerns regarding quality of care.

• Utilize motivational interviewing and coaching techniques to engage members.

• Educate and empower members to make informed healthcare decisions with providers.

• Negotiate and arrange suitable services and resources for members.

• Ensure accurate and timely documentation in compliance with regulatory, accreditation, and company requirements.

• Act as a preceptor and mentor for new nursing and clinical staff.

• Assist with onboarding by instructing on policies, workflows, and best practices.

• Cultivate a positive and supportive learning atmosphere that promotes clinical excellence.

⛳️ Requirements

• Current, unrestricted Registered Nurse (RN) license.

• Bachelor’s degree in Nursing (BSN).

• At least 3 years of clinical experience.

• Minimum of 1 year of experience in case management.

• Preferred experience in a Managed Care Organization (MCO).

• Experience with the STAR Kids program is a plus.

• Bilingual (English/Spanish) is preferred.

• Regular local travel for in-home member visits and occasional visits to nursing facilities is required.

• Willingness to travel up to 75% within the designated territory.

🏝️ Benefits

• Flexible work-from-home options.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Retirement savings opportunities.

• Wellness programs.

• Additional resources to support physical, emotional, and financial wellness.

• CVS Health bonus, commission, or short-term incentive program alongside the base pay range.