Case Manager, Registered Nurse, CVS Health

CVS Health

Location:
United States, Remote

Category:
Nursing

Contract Type:
Employment contract

Salary:

54095.00 - 155538.00 USD / Year

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Job Description:

Remote case manager position working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients, applying clinical judgment and case management processes to ensure appropriate administration of benefits and quality care.

Job Responsibility:

Work as a telephonic case manager with patients and their care team
Application and/or interpretation of applicable criteria and clinical guidelines
Assess benefits and/or member's needs to ensure appropriate administration of benefits
Incorporate strategies designed to reduce risk factors and barriers
Address complex health and social indicators which impact care planning
Consult with supervisor and others in overcoming barriers
Utilize case management processes in compliance with regulatory requirements
Utilize motivational interviewing skills for member engagement
Identify and escalate member's needs appropriately
Actively reach out to members to collaborate/guide their care
Perform medical necessity reviews

Requirements:

5+ years’ experience as a Registered Nurse
1+ year of experience in a hospital setting
Active, unrestricted RN license in state of residence
Willingness to receive multi-state/compact privileges
1+ years' experience documenting electronically using a keyboard
1+ years' current or previous experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/Substance Abuse or Maternity/Obstetrics experience

Nice to have:

1+ years' Case Management experience or discharge planning
1+ years' experience in Utilization Review
CCM and/or other URAC recognized accreditation
1+ years' experience with MCG, NCCN and/or Lexicomp
Bilingual in Spanish
BSN degree

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
Wellness screenings
Tobacco cessation programs
Weight management programs
Confidential counseling
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:
August 27, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Case Manager, Registered Nurse