Case Manager, Registered Nurse

Job not on LinkedIn

🔥 0 minutes ago

🏈 Alabama, North Carolina, +5 more states – Remote

🏈 Alabama – Remote 🌲 North Carolina – Remote 🦀 Maryland – Remote 🎸 Mississippi – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote ⚔️ Virginia – Remote

💵 $54.1k - $116.8k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.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

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

• Perform assessment, planning, facilitation, care coordination, evaluation, and advocacy to address 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 telephonically, in person, and potentially in their homes, worksites, or physician offices • Assess medical and/or vocational status and develop plans of care to optimize wellness, medical outcomes, functioning, and return to work • Communicate with members and stakeholders including medical providers, attorneys, employers, and insurance carriers • Prepare required case work documentation • Consult with internal multidisciplinary teams • Conduct outreach to treating physicians or specialists regarding care and treatment • Provide education and prevention information • Apply laws, regulations, insurer instructions, and referral-source requirements • Evaluate member needs and benefit-plan eligibility using clinical tools and data • Follow case management processes, regulatory requirements, and company policies • Develop proactive action plans and monitor progress toward desired outcomes • Facilitate condition management, wellness, timely return to baseline, optimal function, or return to work

🎯 Requirements

• Active and unrestricted Compact Registered Nurse (RN) Licensure in Alabama, Arkansas, Maryland, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, Georgia, or Florida • 3+ years of clinical practical experience preferred in areas including diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac, or Home Health with Medicare members • 2+ years of case management, discharge planning and/or home health care coordination experience • Proficiency with Microsoft Word, Excel, Outlook, and PowerPoint, plus proprietary applications • Ability to work in a fast-paced, high-volume environment and use time management and prioritization skills • Efficient computer skills, including navigating multiple systems and keyboarding • Associate's Degree in Nursing or Nursing Diploma (REQUIRED) • Comfortable setting up and using multiple monitors and navigating 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 log in to secure systems such as VPN and EHR portals, lock screens, manage strong passwords, and recognize suspicious emails or links • Ability to resolve common technical issues independently • Direct/hardwired internet connection within 7 feet of the modem/router with minimum 25 Mbps download and 3 Mbps upload; WiFi and satellite internet are not permitted • Quiet, secure, private, distraction-free home workspace compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently living • Must provide own workspace furniture for extended desk work • Must obtain required internet speeds and adhere to Work From Home requirements if hired

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay • 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.)