Position Summary
The Nurse Case Manager is responsible for delivering comprehensive case management services through telephonic and/or face-to-face interactions. This role involves assessing, planning, implementing, and coordinating care strategies to support members' medical needs and promote overall wellness. This role operates within established regulatory and organizational policies, applying case management processes and service strategies that align with network management and clinical coverage guidelines. Strong interviewing and engagement skills are critical to understanding member needs and facilitating smooth transitions to appropriate programs and services.
What you will do
- Utilize clinical judgment and data-driven tools to evaluate member eligibility, identify health risks, and develop proactive care plans that address both short- and long-term health outcomes.
- Conduct holistic assessments that consider co-morbid conditions, functional limitations, and social determinants of health.
- Review prior claims, evaluate work capacity, and determine the need for referrals to clinical resources.
- Collaborate with supervisors and multidisciplinary teams is essential to overcome barriers and optimize care planning.
Required Qualifications
- An active and unrestricted RN license in the state of residence.
- Willing and able to obtain additional state licenses upon hire. (Paid for by the company)
- 3+ years' experience of acute care and/or case management.
- 2+ years' Med/Surg experience.
- Must be willing to work Monday-Friday 8:00am-4:30pm local time zone.
Preferred Qualifications
- Prefer candidates in PST Zone.
- Behavioral Health experience.
- Certified Case Manager.
- Managed care experience.
- Strong telephonic communication skills.
- Ability to manage multiple priorities, effective organizational, and time management skills.
- Ability use a computer station and sit for extended periods of time.
Education and Licensing
- Associate's Degree in Nursing.
- RN License in your state of residence.
Work from Home Requirements
- You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 Mbps download and 3 Mbps upload. WiFi and satellite internet are not permitted.
- A quiet, secure, and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
- Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
- The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
- If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.
Technical and Logistical Requirements
- Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
- Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
- Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
- Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
- Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
- Future Growth: Openness to learning new skills in the future as the workplace environment evolves
Anticipated Weekly Hours 40
Time Type Full time
Pay Range
The typical pay range for this role is
$54,095.00 - $116,760.00