The Nurse Case Manager is responsible for delivering comprehensive case management services through telephonic and/or face-to-face interactions.

What you will do

• Utilize 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.
• Conduct holistic assessments that consider co-morbid conditions, functional limitations, and social determinants of health.
• Review prior claims, evaluate work capacity, and determine the need for referrals to clinical resources.
• Collaborate with supervisors and multidisciplinary teams to overcome barriers and optimize care planning.

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 of experience in acute care and/or case management.
• 2+ years of Med/Surg experience.
• Must be willing to work Monday-Friday 8:00am-4:30pm local time zone.

Preferred Qualifications

• Prefer candidates in PST Zone.
• Behavioral Health experience.
• Certified Case Manager.
• Managed care experience.
• Strong telephonic communication skills.
• Ability to manage multiple priorities, effective organisational, and time management skills.
• Ability to use a computer station and sit for extended periods of time.

Work from Home Requirements

• You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 Mbps download and 3 Mbps upload.
• A quiet, secure, and private designated home virtual work location, free from distractions, tidy and organised, compliant with CVS Health and HIPAA guidelines.
• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
• The company will provide equipment (keyboard, monitor, computer, headset, etc.).

Technical and Logistical Requirements

• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.
• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar.
• Systems Access & Security: Ability to Log in to secure systems, lock a computer screen when unattended, manage strong passwords.
• Troubleshooting & Support: Ability to resolve common technical issues independently.

Anticipated Weekly Hours: 40 Time Type: Full time Pay Range: $54,095.00 - $116,760.00

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.

Job Data by YubHub.