Case Manager

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

This Case Manager RN position is 100% remote, and the employee can live in any state. No travel is expected with this position. Normal Working Hours: Monday- Friday, 8:00am - 4:30pm with a 10:30am-7:00pm rotation several times per Quarter in the time zone of residence. Rotational coverage of evenings, weekends and holidays will be per the needs of the department. ? The Case Manager RN utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. The Case Manager RN process includes assessing the member's health status and care coordination needs, inpatient review, and discharge planning, developing, and implementing the case management plan, monitoring, and evaluating the plan and involving the Medical Director as indicated and closing the case as appropriate when the member has met discharge criteria.

The Case Manager RN role requires a nurse that can exercise independent and sound judgment and someone that has strong decision making skills and well-developed interpersonal skills. The Case Manager RN is expected to manage multiple priorities, demonstrate both effective organizational and time management skills as well demonstrate strong teamwork skills. The responsibilities of this Case Manager RN position are to: -Apply data driven methods of identification of members to fashion individualized case management programs and/or referrals to alternative healthcare programs. -Conduct comprehensive clinical assessments. -Evaluate needs and develop flexible approaches based on member needs, benefit plans or external programs/services. -Advocate for patients to the full extent of existing health care coverage. -Promote quality, cost effective outcomes, and make suggestions to improve program/operational efficiency. -Identify and escalate quality of care issues through established channels. -Provide an expected very high level of customer service. -Utilize assessment techniques to determine member's level of health literacy, technology capabilities, and/or readiness to change. -Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. -Provide coaching, information, education, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.

Required Qualifications

Active and unrestricted RN license in their state of residence and must be willing and able to obtain multi-state licensure upon hire - - 3+ years of acute care experience as an RN - 3+ years of experience with Microsoft Office suite of products

Preferred Qualifications -

Compact RN License - Certified Case Manager (CCM) - Case Management experience - Managed Care experience - Telephonic case management and/or telephonic customer service center experience - 3+ years of Oncology Care experience

Education -

Minimum of Associate Degree in Nursing required -

BSN preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,095.00 - $155,538.00

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: 12/04/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.