Case Manager, Registered Nurse

Job not on LinkedIn

🔥 2 hours ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $54.1k - $155.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Work intensely as a telephonic case manager with patients and their care teams for fully and/or self-insured clients • Apply and interpret applicable criteria, clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards • Assess benefits and member needs to ensure appropriate administration of benefits • Apply clinical judgment and strategies to reduce risk factors and barriers and address complex health and social indicators affecting care planning • Assess information from various sources, including co-morbidities and multiple diagnoses affecting functionality • Consult with supervisors, clinical colleagues, Medical Directors, and other programs to overcome barriers • Present cases at multidisciplinary case conferences to support overall claim management • Use case management processes in compliance with regulatory and company policies and procedures • Use motivational interviewing to maximize member engagement and assess health status and needs • Identify and appropriately escalate member needs according to guidelines and protocols • Actively reach out to members to collaborate on and guide their care • Perform medical necessity reviews

🎯 Requirements

• 5+ years’ experience as a Registered Nurse, including at least 1 year in a hospital setting • Active multistate RN license through the Nurse Licensure Compact (NLC) for nurses residing in compact states, or individual state-specific RN licenses for each supported state for nurses in non-compact states • 1+ years’ experience documenting electronically using a keyboard • 1+ years’ current or previous experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/Substance Abuse, or Maternity/Obstetrics • Nursing diploma or Associate Degree in Nursing required • 1+ years’ Case Management, discharge planning, nurse navigator, or nurse care coordinator experience preferred • Experience transferring patients to lower levels of care preferred • 1+ years’ Utilization Review experience preferred • CCM and/or other URAC-recognized accreditation preferred • 1+ years’ experience with MCG, NCCN, and/or Lexicomp preferred • Bilingual Spanish preferred • Bachelor’s degree preferred

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being

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