Case Manager Registered Nurse - Work at Home at CVS Health

Wichita Falls, Texas, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Active, current, and unrestricted RN licensure in the state of residence and willingness to apply for a Compact RN (fees paid by company)
5 years clinical practice experience as an RN
Ability to work Monday through Friday between the hours of 7:00am to 6:00pm CST (subject to change based on business needs)
Associate Degree required (BSN preferred)

Responsibilities

Telephonically assessing, planning, implementing, and coordinating all case management activities with members to evaluate medical needs and facilitate overall wellness
Developing a proactive course of action to address issues and enhance short- and long-term outcomes through integration
Conducting evaluations of member’s needs and benefit plan eligibility using clinical tools and data review, facilitating transitions to programs and plans
Applying clinical judgment to incorporate strategies reducing risk factors and barriers, addressing complex health and social indicators impacting care planning
Considering information from various sources in assessments to address all conditions, including co-morbid and multiple diagnoses impacting functionality
Reviewing prior claims to address potential impact on current case management plan
Assessing member’s level of work capacity and related restrictions/limitations
Using a holistic approach to assess need for referral to clinical resources
Consulting with supervisor and others to overcome barriers, presenting cases at case conferences for multidisciplinary focus
Utilizing case management processes in compliance with regulatory and company policies and procedures
Utilizing interviewing skills to ensure maximum member engagement and discern health status and needs

Skills

Key technologies and capabilities for this role

RNCase ManagementTelephonic AssessmentCare PlanningClinical JudgmentRisk AssessmentClaims Review

Questions & Answers

Common questions about this position

Is this a remote position?

Yes, this is a work-at-home position as indicated by the job title 'Case Manager Registered Nurse - Work at Home'.

What are the required qualifications for this role?

Candidates must have an active, current, and unrestricted RN licensure in the state of residence (willing to apply for Compact RN, fees paid by company) and 5 years of clinical practice experience as an RN. They must also be able to work Monday through Friday between 7:00am to 6:00pm CST.

What are the working hours for this position?

The position requires working Monday through Friday between 7:00am to 6:00pm CST, with currently no nights, weekends, or holidays, though this is subject to change based on business needs.

What is the salary for this position?

This information is not specified in the job description.

What makes a strong candidate for this RN Case Manager role?

A strong candidate will have an active RN license, 5+ years of clinical experience, and preferably 6+ months of case management experience, along with skills in telephonic assessments, clinical judgment, and member engagement.

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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