Case Manager, Registered Nurse - Fully Remote

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

• Working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients.
• Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, policies, procedures and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits.
• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
• Assessments utilize information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
• Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
• Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversations.
• Identifies and escalates member’s needs appropriately following set guidelines and protocols.
• Need to actively reach out to members to collaborate/guide their care.
• Perform medical necessity reviews.

• 5+ years’ experience as a Registered Nurse with at least 1 year of experience in a hospital setting.
• A Registered Nurse that holds an active, unrestricted license in their state of residence, and willingness to receive a multi-state/compact privileges and can be licensed in all 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 experience

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• Employee stock purchase plan
• No-cost programs for all colleagues (including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching)
• Benefit solutions that address the different needs and preferences of our colleagues (including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility)

CVS Health is a leading health solutions company that reaches millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues.