Case Manager, RN

Job not on LinkedIn

🔥 14 hours ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $54.1k - $116.8k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

👻 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

• Telephonically assess, plan, implement, and coordinate case management activities with members • Evaluate members’ medical needs and facilitate overall wellness • Develop proactive courses of action to address issues and enhance short- and long-term outcomes • Use clinical tools and data review to evaluate member needs and benefit plan eligibility • Facilitate integrative functions and smooth transitions to Aetna programs and plans • Apply clinical judgment to reduce risk factors and address complex health and social indicators • Assess co-morbidities, multiple diagnoses, functionality, work capacity, and restrictions or limitations • Review prior claims for potential impact on current case management and eligibility • Refer members to clinical resources when needed to determine functionality • Consult with supervisors and others to overcome barriers and meet goals • Present cases at multidisciplinary case conferences • Follow regulatory and company case management policies and procedures • Use interviewing skills to engage members and determine health status and needs • Work Monday through Friday, 9:00am–5:30pm EST, with occasional evening and holiday shifts • Travel 0–10% possible, including travel to the High Point office for customer meetings if residing within 30 miles

🎯 Requirements

• Must live in North Carolina • Must have an active and unrestricted RN license in North Carolina • 2+ years of clinical experience as an RN • Associates Degree in Nursing • Multiple-state RN licensure welcomed but not required; if chosen, must be willing and able to obtain it after hire • Direct/hardwired internet connection to a modem/router within 7 feet of the computer • Minimum internet speed of 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 simultaneously • Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings • Experience with Microsoft Office 365 applications or similar Google Workspace applications • Ability to log in to secure systems such as VPN and EHR portals • Ability to maintain strong passwords and recognize suspicious emails or links • Ability to troubleshoot common technical issues independently • Openness to learning new skills, including working with AI tools and products • Preferred: Certified Case Manager (CCM) certification • Preferred: 3+ years’ experience with Microsoft Office Suite • Preferred: Case Management in an integrated model • Preferred: Discharge Planning experience • Preferred: Managed care experience • Preferred: BSN

🏖️ 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 work equipment including keyboard, monitor, computer, and headset • Expenses paid by the company for multiple-state RN licensure if obtained after hire