Case Manager, Registered Nurse

Job not on LinkedIn

🔥 0 minutes ago

🏖️ New Jersey, New York, +3 more states – Remote

🏖️ New Jersey – Remote 🗽 New York – Remote 🏈 Ohio – Remote 🍂 Massachusetts – Remote 🔔 Pennsylvania – Remote

💵 $66.6k - $142.6k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 0%

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Facilitate delivery of appropriate benefits and healthcare information while promoting wellness activities • Conduct assessment, planning, facilitation, care coordination, evaluation, and advocacy for members’ and families’ comprehensive health needs • Act as liaison among members, clients, families, employers, providers, insurance companies, and healthcare personnel • Implement and coordinate case management activities for catastrophic cases and chronically ill members across the continuum of care • Coordinate consultant referrals, home care visits, community resources, and alternative levels of care • Interact with members and clients telephonically or in person, including in homes, worksites, or physician offices when required • Assess and analyze medical and/or vocational status and develop plans of care • Communicate with members and stakeholders including medical providers, attorneys, employers, and insurance carriers • Prepare required case work documentation • Consult with internal multidisciplinary teams • Contact treating physicians or specialists regarding care and treatment • Provide education and prevention information • Apply applicable laws, regulations, insurer instructions, and referral-source requirements • Evaluate member needs and benefit-plan eligibility using clinical tools and data • Facilitate condition management, wellness, medical outcomes, return to baseline, optimal function, and return to work • Develop proactive action plans to address issues and improve short- and long-term outcomes • Monitor member progress toward desired outcomes through assessment and evaluation

🎯 Requirements

• Active and unrestricted Compact Registered Nurse License in the state of residence and/or a Single State Massachusetts (MA), New York (NY) Registered Nurse License • 3+ years clinical practical experience preferred, including diabetes, CHF, CKD, post-acute care, hospice, palliative care, or cardiac experience with Medicare members • 2+ years case management, discharge planning and/or home health care coordination experience • Proficiency with MS Word, Excel, Outlook, PowerPoint, and proprietary applications • Excellent analytical and problem-solving skills • Effective communication, organizational, and interpersonal skills • Ability to work independently • Bilingual preferred • Certified Case Manager preferred • Willing and able to obtain multi-state Registered Nurse licenses if needed • National professional certification (CRC, CDMS, CRRN, COHN, or CCM) preferred • Associate's Degree in Nursing (REQUIRED) • Direct/hardwired internet connection to a modem/router within 7 feet of the computer, with minimum 25 Mbps download and 3 Mbps upload • WiFi and satellite internet are not permitted • Quiet, secure, private designated home virtual work location compliant with CVS Health and HIPAA guidelines • Ability to use multiple monitors and navigate multiple applications • Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings • Experience with Microsoft Office 365 or similar Google Workspace applications • Ability to access secure systems such as VPN and EHR portals, follow computer security practices, and recognize suspicious emails or links • Ability to resolve common technical issues independently • Openness to learning new skills as the workplace evolves

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to the base pay range • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • Company-provided equipment (keyboard, monitor, computer, headset, etc.)