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Case Manager, Registered Nurse
CVS Health. Perform assessment, planning, facilitation, care coordination, evaluation, and advocacy for members’ and families’ comprehensive health needs .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in case management, care coordination, and comprehensive health assessments, with a strong focus on member advocacy and wellness outcomes. Proficient in utilizing clinical tools and data to evaluate member needs and eligibility while ensuring compliance with healthcare regulations.
Highest-signal resume keywords
Active Registered Nurse LicensureCase Management ExperienceClinical Practical ExperienceProficiency in Microsoft Office 365Ability to Navigate Multiple Systems
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Case ManagementCare CoordinationHealth AssessmentCondition ManagementMedical Outcomes EvaluationDocumentation PreparationClinical Tools UtilizationBenefit-Plan Eligibility EvaluationOutreach to PhysiciansEducation and Prevention Information
Soft Skills
Time ManagementPrioritization SkillsCommunication SkillsInterpersonal SkillsProblem-Solving Skills
Tools & Technologies
Microsoft WordMicrosoft ExcelMicrosoft OutlookMicrosoft PowerPointProprietary ApplicationsVPNEHR PortalsTeams MessagingGoogle WorkspaceMultiple Monitors
Certifications & Qualifications
Compact Registered Nurse LicensureAssociate's Degree in NursingBachelor's Degree in Nursing
Industry Keywords
Home Health CareChronic Illness ManagementMedicarePalliative CareDischarge PlanningHealth InsuranceHIPAA ComplianceTelehealthVocational AssessmentCommunity Resources
About the role
Key responsibilities & impact- Perform assessment, planning, facilitation, care coordination, evaluation, and advocacy for members’ and families’ comprehensive health needs
- Act as a liaison among members/clients/families, employers, providers, insurance companies, and healthcare personnel
- Implement and coordinate case management activities for catastrophic cases and chronically ill members/clients across the continuum of care
- Coordinate consultant referrals, home care visits, community resources, and alternative levels of care
- Interact with members/clients telephonically or in person, including in homes, worksites, or physician offices
- Assess and analyze medical and/or vocational status
- Develop plans of care to support condition management, wellness, medical outcomes, return to work, optimal functioning, and benefits eligibility
- Communicate with members/clients and stakeholders including medical providers, attorneys, employers, and insurance carriers
- Prepare required case work documentation
- Consult with internal multidisciplinary teams
- Conduct outreach to treating physicians or specialists regarding care and treatment
- Provide education and prevention information
- Apply laws, regulations, insurance-carrier instructions, and referral-source requirements
- Evaluate member needs and benefit-plan eligibility using clinical tools and data
- Monitor member progress toward desired outcomes through assessment and evaluation
- Develop proactive courses of action to improve short- and long-term outcomes and overall wellness
Requirements
What you’ll need- Active and unrestricted Compact Registered Nurse (RN) Licensure in Alabama, Arkansas, Maryland, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, Georgia, or Florida
- 3+ years of clinical practical experience preferred in areas such as diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac, or Home Health with Medicare members
- 2+ years of case management, discharge planning and/or home health care coordination experience
- Proficiency with Microsoft Word, Excel, Outlook, PowerPoint, and proprietary applications
- Ability to work in a fast-paced, high-volume environment
- Time management and prioritization skills
- Efficient computer skills, including navigating multiple systems and keyboarding
- Associate's Degree in Nursing or Nursing Diploma (REQUIRED)
- Bachelor's Degree in Nursing (PREFERRED)
- 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
- Must work within the state and city where currently living
- Must provide own workspace furniture, such as a desk or standing desk
- Ability to use multiple monitors and navigate multiple applications
- Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings
- Experience with Microsoft Office 365 applications or similar tools such as Google Workspace
- Ability to log in to secure systems such as VPN and EHR portals
- Ability to lock computer screens, manage strong passwords, and recognize suspicious emails or links
- Ability to resolve common technical issues independently
- Openness to learning 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 well-being resources, based on eligibility
- Company-provided equipment including keyboard, monitor, computer, and headset