Case Manager Registered Nurse - Work at Home

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Overview

This RN Case Manager role is 100% remote and the employee can live in any state and telework; however, there is a preference for an RN in a Compact RN state. Normal hours are Monday through Friday 8:00am – 4:30pm in the time zone of residence with occasional late shift rotation until 7:00pm EST. Employees can flex their 8-hour shift between 8:00am-6:00pm. Travel of less than 5% may be required in the event of clinical audits. There are no weekends or holiday shifts required at this time.

Responsibilities

• Telephonically and/or face-to-face assessing, planning, implementing, and coordinating all case management activities with members to evaluate medical needs and facilitate overall wellness.
• Develops a proactive course of action to address issues presented to enhance short- and long-term outcomes and overall wellness through integration.
• Use clinical tools and data review to evaluate member needs and benefit plan eligibility and facilitate transitions to Aetna programs and plans.
• Apply clinical judgment to reduce risk factors and address complex health and social indicators impacting care planning and resolution of issues.
• Consider information from multiple sources to address all conditions including co-morbidity and functional impact.
• Review prior claims to assess potential impact on current case management and eligibility.
• Assess the member’s level of work capacity and related restrictions/limitations.
• Assess need for referrals to clinical resources to determine functionality.
• Consult with supervisor and colleagues to overcome barriers and present cases at case conferences for multidisciplinary input.
• Utilize case management processes in compliance with regulatory and company policies and procedures.
• Use interviewing skills to ensure member engagement and accurately discern health status and needs.

Required Qualifications

• Must have an active and unrestricted RN license
• Willingness and ability to obtain additional state licenses upon hire (paid for by the company)
• 3+ years of acute hospital clinical experience as an RN (general medical, post-surgical, ICU experience)

Preferred Qualifications

• 1+ years of case management experience
• Compact RN licensure
• Certified Case Manager (CCM) certification
• Experience with all types of Microsoft Office including PowerPoint, Excel, and Word
• Strong telephonic communication skills

Education

• Associates Degree in Nursing is minimum required. BSN preferred.

Additional Details

• Anticipated Weekly Hours: 40
• Time Type: Full time
• Pay Range: The Typical Pay Range For This Role Is $54,095.00 - $116,760.00

Benefits

• 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 addressing diverse needs and preferences including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and more depending on eligibility.

For more information, visit cvshealth job benefits page. We anticipate the application window for this opening will close on: 10/31/2025. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.