Case Manager, Registered Nurse, CVS Health

CVS Health

Location:
United States, Work At Home, Florida

Category:
Nursing

Contract Type:
Not provided

Salary:

54095.00 - 116760.00 USD / Year

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Job Description:

Community Care Case Manager (CM) use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes.

Job Responsibility:

Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate
Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care
Interacts with members/clients telephonically or in person
May be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services
Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status
develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate
Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person
Prepares all required documentation of case work activities as appropriate
Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes
May make outreach to treating physician or specialists concerning course of care and treatment as appropriate
Provides educational and prevention information for best medical outcomes
Applies all laws and regulations that apply to the provision of rehabilitation services
applies all special instructions required by individual insurance carriers and referral sources
Testifies as required to substantiate any relevant case work or reports
Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data
Utilizes case management processes in compliance with regulatory and company policies and procedures
Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work
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/client’s overall wellness through integration
Monitors member/client progress toward desired outcomes through assessment and evaluation

Requirements:

3 years clinical practical experience: (Diabetes, CHF, CKD, Post-Acute Care, Hospice, Palliative Care, Cardiac) with Medicare members
Registered Nurse with active state license in good standing within the region where job duties are performed is required
Ability to occasionally travel within a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs arise

Nice to have:

2 years CM, Discharge Planning, and/or Home Healthcare coordination experience preferred
Excellent analytical and problem-solving skills
Effective communications, organizational, and interpersonal skills
Ability to work independently (may require working from home)
Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications
Efficient and Effective computer skills including navigating multiple systems and keyboarding
Compact RN licensure
Certified Case Manager
Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM)
Bachelors of Science in Nursing

What we offer:

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an 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

Additional Information:

Job Posted:
August 06, 2025

Expiration:
August 15, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Case Manager, Registered Nurse