CVS Health is looking for a Case Manager, Registered Nurse with Oncology experience to join our team. In this fully remote role, you will apply your clinical expertise to perform telephonic case management, ensuring patients receive appropriate care and that benefits are administered effectively according to clinical guidelines and care plans. You'll be part of our mission to shape a more connected and compassionate health experience.
What You'll Do
- Work intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients.
- Apply and/or interpret applicable criteria, clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs.
- Apply clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators impacting care planning.
- Conduct assessments utilizing information from various sources to address all conditions including co-morbid and multiple diagnoses impacting functionality.
- Consult with supervisor and others to overcome barriers, presenting cases at case conferences for multidisciplinary focus.
- Using a holistic approach, consult with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers.
- Utilize case management processes in compliance with regulatory and company policies and procedures.
- Utilize motivational interviewing skills to ensure maximum member engagement and discern health status and needs.
- Identify and escalate member’s needs appropriately following set guidelines and protocols.
- Actively reach out to members to collaborate/guide their care.
- Perform medical necessity reviews.
What We're Looking For
- 5+ years’ experience as a Registered Nurse, including at least 1 year 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 privilege 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.
- Diploma or Associates Degree in Nursing required.
Nice to Have
- 1+ years’ Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience as well as experience with transferring patients to lower levels of care.
- 1+ years' experience in Utilization Review.
- CCM and/or other URAC recognized accreditation preferred.
- 1+ years’ experience with MCG, NCCN and/or Lexicomp.
- Bilingual in Spanish preferred.
- Bachelors Degree.
Benefits & Compensation
- Compensation range: $54,095.00 - $142,576.00
- 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 including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access.
Work Mode
This is a fully remote position open to candidates located within the United States.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
