CVS Health is seeking a Case Manager Registered Nurse to support our Commercial Plans members. In this role, you will conduct telephonic and in-person assessments to develop proactive care plans and coordinate comprehensive case management services that promote wellness and improve health outcomes.
What You'll Do
- Develop proactive, individualized care strategies to improve short- and long-term health outcomes.
- Use clinical tools, data, and member benefit information to assess needs and determine eligibility for services.
- Apply clinical judgment to implement strategies that reduce risk factors and address medical, behavioral, and social determinants of health.
- Conduct holistic assessments using diverse information sources to evaluate all conditions affecting daily function.
- Review historical claims to identify impacts on current case management needs.
- Evaluate members' functional capacity, including work capabilities and restrictions.
- Use a whole-person approach to determine referrals to specialized clinical resources.
- Collaborate with supervisors and interdisciplinary teams to address barriers and support case objectives.
- Follow established case management protocols aligned with regulatory requirements.
- Utilize strong interviewing skills to engage members and understand their care needs.
What We're Looking For
- Active, unrestricted Registered Nurse (RN) license in state of residence; multi-state/compact licensure preferred.
- Ability to obtain licensure in all non-compact states.
- Minimum of 3 years of clinical experience.
- Associate Degree in Nursing.
Nice to Have
- Compact RN licensure.
- Case management experience.
- Case Manager Certification (e.g., CCM).
- Proficiency with Windows and Microsoft Office.
- Strong computer and documentation skills.
- Bachelor of Science in Nursing (BSN).
Technical Stack
- Windows
- Microsoft Office
Benefits & Compensation
- Compensation range: $66,575.00 - $142,576.00.
- Affordable medical plan options.
- 401(k) plan with matching company contributions.
- Employee stock purchase plan.
- No-cost programs including wellness screenings, tobacco cessation, weight management, counseling, and financial coaching.
- Paid time off, flexible work schedules, family leave, dependent care resources, tuition assistance, and retiree medical access.
Work Mode
This is a fully remote position. Candidates must be located within the Pacific Time Zone (PST).
CVS Health is committed to fostering a workplace where every colleague feels valued and that they belong. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all applicable laws.
