Case Manager RN
$60,522–$129,615 year
RemotePennsylvania, United States
Job Summary
Conduct telephonic assessments to evaluate members' medical, behavioral, and social needs, then develop individualized care plans that support improved health outcomes. Identify barriers to care and implement strategies to reduce risk while coordinating care across providers, programs, and community resources. Review clinical information, claims history, and benefit eligibility to support appropriate interventions, utilizing motivational interviewing and clinical judgment to engage members. Collaborate with multidisciplinary teams to address complex cases and ensure compliance with regulatory requirements and company standards. Work remotely Monday through Friday, with occasional late-shift rotation and holiday on-call coverage as needed.
Required Qualifications
- Active, unrestricted RN license in your state of residence
- Ability to obtain multi-state/compact licensure (company-paid)
- 3+ years of clinical nursing experience
- 1+ year of experience using Microsoft Office (Outlook, Word, Excel)
- Ability to work Monday–Friday with schedules starting as early as 8:00 AM in your local time zone
- Ability to participate in rotating late shifts (up to 8:00 PM EST) and holiday on-call coverage as needed
- Associate Degree in Nursing
- You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer
- Minimum download speed of 25 mbs download and 3 mbs 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
- All new hires should provide their own workspace furniture (desk or standing desk)
- Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency
- Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings
- Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace)
- 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
- 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
- Openness to learning new skills in the future as the workplace environment evolves
Desired Qualifications
- Compact RN license
- Case Management experience
- Case Manager Certification (CCM or equivalent)
- BSN preferred
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