Case Manager, RN

Job Description:

• Telephonically assess, plan, implement, and coordinate case management activities with members
• Evaluate members’ medical needs and facilitate overall wellness
• Develop proactive courses of action to address issues and enhance short- and long-term outcomes
• Use clinical tools and data review to evaluate member needs and benefit plan eligibility
• Facilitate integrative functions and smooth transitions to Aetna programs and plans
• Apply clinical judgment to reduce risk factors and address complex health and social indicators
• Assess co-morbidities, multiple diagnoses, functionality, work capacity, and restrictions or limitations
• Review prior claims for potential impact on current case management and eligibility
• Refer members to clinical resources when needed to determine functionality
• Consult with supervisors and others to overcome barriers and meet goals
• Present cases at multidisciplinary case conferences
• Follow regulatory and company case management policies and procedures
• Use interviewing skills to engage members and determine health status and needs
• Work Monday through Friday, 9:00am–5:30pm EST, with occasional evening and holiday shifts
• Travel 0–10% possible, including travel to the High Point office for customer meetings if residing within 30 miles

Requirements:

• Must live in North Carolina
• Must have an active and unrestricted RN license in North Carolina
• 2+ years of clinical experience as an RN
• Associates Degree in Nursing
• Multiple-state RN licensure welcomed but not required; if chosen, must be willing and able to obtain it after hire
• Direct/hardwired internet connection to a modem/router within 7 feet of the computer
• Minimum internet speed of 25 Mbps download and 3 Mbps upload
• WiFi and satellite internet are not permitted
• Quiet, secure, private designated home virtual work location compliant with CVS Health and HIPAA guidelines
• Ability to use multiple monitors and navigate multiple applications simultaneously
• Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings
• Experience with Microsoft Office 365 applications or similar Google Workspace applications
• Ability to log in to secure systems such as VPN and EHR portals
• Ability to maintain strong passwords and recognize suspicious emails or links
• Ability to troubleshoot common technical issues independently
• Openness to learning new skills, including working with AI tools and products
• Preferred: Certified Case Manager (CCM) certification
• Preferred: 3+ years’ experience with Microsoft Office Suite
• Preferred: Case Management in an integrated model
• Preferred: Discharge Planning experience
• Preferred: Managed care experience
• Preferred: BSN

Benefits:

• CVS Health bonus, commission or short-term incentive program in addition to base pay
• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources supporting physical, emotional, and financial well-being
• Company-provided work equipment including keyboard, monitor, computer, and headset
• Expenses paid by the company for multiple-state RN licensure if obtained after hire