Case Manager, Registered Nurse

Job not on LinkedIn

🔥 16 hours ago

🏈 Alabama, Alaska, +44 more states – Remote

🏈 Alabama – Remote 🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🏛️ District of Columbia – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $54.1k - $155.5k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 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

• 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 to reduce risk factors and barriers and address complex health and social indicators affecting care planning • Conduct assessments using information from various sources, including co-morbid and multiple diagnoses affecting functionality • Consult with supervisors and others to overcome barriers and meet goals and objectives • Present cases at case conferences for multidisciplinary review and overall claim management • Consult with clinical colleagues, supervisors, Medical Directors, and other programs using a holistic approach • Use case management processes in compliance with regulatory and company policies and procedures • Use motivational interviewing to maximize member engagement and determine health status and needs • Identify and appropriately escalate member needs following 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 of experience 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 Associates Degree in Nursing required • 1+ years’ Case Management, discharge planning, nurse navigator, or nurse care coordinator experience preferred • 1+ years’ experience transferring patients to lower levels of care preferred • 1+ years’ experience in Utilization Review preferred • CCM and/or other URAC recognized accreditation preferred • 1+ years’ experience with MCG, NCCN, and/or Lexicomp preferred • Bilingual in 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 • Virtual training