CVS Health is hiring a Registered Nurse, Case Manager to support patients and their care teams in a remote, telephonic role. You will apply clinical judgment and established criteria to ensure the appropriate administration of benefits and develop comprehensive care plans, contributing to CVS Health's mission of transforming healthcare.
What You'll Do
- Work telephonically as a case manager with patients and their care teams.
- Apply and interpret clinical guidelines, care plans, policies, and regulatory standards.
- Assess member needs and benefits to ensure appropriate care administration.
- Use clinical judgment to develop strategies that reduce risk factors and address complex health indicators.
- Conduct assessments using various data sources to address co-morbid and multiple diagnoses.
- Consult with supervisors and colleagues to overcome barriers and present cases for multidisciplinary review.
- Collaborate with clinical peers, Medical Directors, and other programs using a holistic approach.
- Utilize case management processes in compliance with all regulatory and company policies.
- Employ motivational interviewing to maximize member engagement and discern health status.
- Identify and escalate member needs according to established protocols.
- Proactively reach out to members to guide their care.
- Perform medical necessity reviews.
What We're Looking For
- 5+ years of experience as a Registered Nurse (RN).
- At least 1 year of experience in a hospital setting.
- Active, unrestricted RN license in your state of residence, with willingness to obtain multi-state/compact privileges.
- 1+ years of current or previous experience in Medical/Surgical, Oncology, Transplant, Behavioral Health, or Specialty Pharmacy.
- 1+ years of experience documenting electronically using a keyboard.
- Diploma or Associate's Degree in Nursing.
Nice to Have
- 1+ years of Case Management experience, or experience in discharge planning, nurse navigation, or care coordination.
- Experience transferring patients to lower levels of care.
- 1+ years of experience in Utilization Review.
- CCM and/or other URAC recognized accreditation.
- 1+ years of experience with MCG, NCCN, and/or Lexicomp.
- Bilingual in Spanish.
- BSN degree.
Team & Environment
You will consult regularly with your supervisor, clinical colleagues, Medical Directors, and other programs.
Benefits & Compensation
- Compensation range: $54,095.00 - $155,538.00.
- Affordable medical plan options.
- 401(k) plan with matching company contributions.
- Employee stock purchase plan.
- No-cost wellness screenings, tobacco cessation, and weight management programs.
- No-cost confidential counseling and financial coaching.
- 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 within the United States.
CVS Health is an equal opportunity employer. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all applicable federal, state, and local laws.
