Case Manager, Registered Nurse

CVS Health

. Facilitate delivery of benefits and healthcare information determining benefit eligibility .

Posted 10/6/2026full-timeRemote • United StatesMid-LevelSenior💰 $54,095 - $116,760 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in case management, care coordination, and benefit eligibility assessment for healthcare members, with a strong focus on improving health outcomes and wellness. Proficient in utilizing clinical tools and data to evaluate member needs and develop individualized care plans.

Highest-signal resume keywords

Active Compact Registered Nurse (RN) License3+ Years Clinical Practical Experience2+ Years Case Management ExperienceCertified Case Manager PreferredExperience with Microsoft Office 365

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case ManagementCare CoordinationBenefit Eligibility AssessmentClinical Tools UtilizationIndividualized Care PlanningAssessment of Medical and Vocational StatusDocumentation PreparationMonitoring Progress Toward OutcomesEducation and Prevention InformationTroubleshooting Technical Issues

Soft Skills

Analytical SkillsProblem-Solving SkillsEffective CommunicationOrganizational SkillsInterpersonal SkillsAbility to Work Independently

Tools & Technologies

EHR PortalsVPNMicrosoft Office 365Google WorkspaceSecure Systems

Certifications & Qualifications

Compact Registered Nurse (RN) LicenseCertified Case Manager (CCM)National Professional Certifications (CRC, CDMS, CRRN, COHN)

Industry Keywords

HealthcareCase ManagementChronic IllnessHome Health CareMedicare MembersPalliative CareWellness ActivitiesHIPAA ComplianceDischarge PlanningCatastrophic Cases

About the role

Key responsibilities & impact

Facilitate delivery of benefits and healthcare information determining benefit eligibility
Promote wellness activities and support Health Strategies, policies, and programs
Conduct assessment, planning, facilitation, care coordination, evaluation, and advocacy for members and families
Act as liaison among members, families, employers, providers, insurers, and healthcare personnel
Coordinate case management for catastrophic cases and chronically ill members across the continuum of care
Coordinate consultant referrals, home care visits, community resources, and alternative levels of care
Interact with members by telephone or in person, including at homes, worksites, or physician offices
Assess medical and vocational status and develop individualized plans of care
Communicate with providers, attorneys, employers, insurance carriers, and other stakeholders
Prepare required case-work documentation
Consult with internal multidisciplinary teams and treating physicians or specialists
Provide education and prevention information
Apply laws, regulations, insurer instructions, and referral-source requirements
Evaluate member needs and benefit-plan eligibility using clinical tools and data
Monitor progress toward desired outcomes and optimize wellness, medical outcomes, function, and return to work
Develop proactive courses of action to improve short- and long-term outcomes

Requirements

What you’ll need

Candidates must reside in the Southeast Region: FL, GA, AL, MS, NC, SC, TN, OH, AK, KY, VA
Active and unrestricted Compact Registered Nurse (RN) license and residence in a compact state
3+ years clinical practical experience, preferably in diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac, or home health with Medicare members
2+ years case management, discharge planning and/or home health care coordination experience
Dependents must have separate care arrangements during work hours
Access to a private, dedicated workspace
Excellent analytical and problem-solving skills
Effective communication, organizational, and interpersonal skills
Ability to work independently
Certified Case Manager preferred
National professional certification such as CRC, CDMS, CRRN, COHN, or CCM preferred
Efficient computer skills, including navigating multiple systems and keyboarding
Willingness and ability to obtain multi-state RN licenses if needed
Associate's Degree in Nursing required
Bachelor's Degree in Nursing preferred
Direct/hardwired internet connection within 7 feet of the modem/router, with minimum 25 Mbps download and 3 Mbps upload; WiFi and satellite internet are not permitted
Quiet, secure, private home work location compliant with CVS Health and HIPAA guidelines
Must work within the state and city where currently residing
Experience with Microsoft Office 365 applications or similar Google Workspace tools
Ability to use VPN and EHR portals, secure systems, strong passwords, and recognize suspicious emails or links
Ability to troubleshoot common technical issues independently
Ability to learn new skills as the workplace evolves

Benefits

Comp & perks

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 equipment (keyboard, monitor, computer, headset, etc.)
Company-provided multi-state RN licenses if needed