Case Manager Registered Nurse - Work at home

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary: Nurse Case Manager

• 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. The Nurse Case Manager utilizes 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.
• Key responsibilities include conducting holistic assessments that consider co-morbid conditions, functional limitations, and social determinants of health. The Nurse Case Manager reviews prior claims, evaluates work capacity, and determines the need for referrals to clinical resources. Collaboration with supervisors and multidisciplinary teams is essential to overcome barriers and optimize care planning.
• 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.

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 who reside in Pacific Standard Time Zone
• Behavioral Health experience
• Certified Case Manager
• Case Management experience
• 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

• Minimum of an Associate's Degree in Nursing or Diploma RN Required

Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $66,575.00 - $142,576.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 11/01/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Apply tot his job Apply To this Job