Case Manager Registered Nurse Job at CVS Health (Work at Home)

Case Manager Registered Nurse

CVS Health

Location:
United States , Work at Home

Category:
Nursing

Contract Type:
Not provided

Salary:

66575.00 - 142576.00 USD / Year

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Job Description:

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Job Responsibility:

Telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness
Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration
Through the use of clinical tools and information/data review, conducts an evaluation of member’s needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans
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 take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality
Reviews prior claims to address potential impact on current case management and eligibility
Assessments include the member’s level of work capacity and related restrictions/limitations
Using a holistic approach assess the need for a referral to clinical resources for assistance in determining 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
Utilizes case management processes in compliance with regulatory and company policies and procedures
Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation

Requirements:

Must have an active Illinois RN licensure (does not need to live in Illinois)
2+ years of clinical experience as an RN
All clinical experience will be considered, such as Emergency Department, Home Health, Hospice, Operating Room, ICU, NICU, Telemetry, Medical / Surgical, Orthopedics, Long Term Care, and Infusion nursing

Nice to have:

Certified Case Manager (CCM) certification
3+ years’ experience with Microsoft Office Suite
Case Management in an integrated model
Discharge Planning experience
Managed care experience
BSN preferred

What we offer:

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
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
March 04, 2026

Expiration:
March 07, 2026

Employment Type:

Fulltime

Work Type:

Remote work

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