Case Manager, Registered Nurse – Medicare

CVS Health

. Facilitate delivery of appropriate benefits and healthcare information and determine benefit eligibility .

Posted 10/13/2026full-timeRemote • Pennsylvania • United StatesJuniorMid-Level💰 $60,522 - $129,615 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in case management, including assessment, planning, and coordination of care for Medicare members. Proficient in utilizing clinical tools and data to evaluate needs and benefit eligibility while ensuring compliance with healthcare regulations.

Highest-signal resume keywords

Registered Nurse LicensureCase Management ExperienceClinical Practical ExperienceAnalytical SkillsEffective Communication

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Assessment and EvaluationCare CoordinationIndividualized Plans of CareBenefit Eligibility EvaluationRehabilitation Services Regulations

Soft Skills

Problem-Solving SkillsOrganizational SkillsInterpersonal SkillsAbility to Work Independently

Tools & Technologies

Microsoft Office SuiteProprietary ApplicationsEHR PortalsVPN SystemsGoogle Workspace

Certifications & Qualifications

Registered Nurse LicenseCertified Case Manager

Industry Keywords

MedicareChronic Illness ManagementHome Health CarePalliative CareHealth Strategies

About the role

Key responsibilities & impact

Facilitate delivery of appropriate benefits and healthcare information and determine benefit eligibility
Promote wellness activities and support health strategies, policies, and programs
Assess, plan, coordinate, facilitate, evaluate, and advocate for members’ comprehensive health needs
Act as liaison among members, families, employers, providers, insurers, and healthcare personnel
Coordinate case management for catastrophic cases and chronically ill Medicare 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 possible home, worksite, or physician-office visits
Assess medical and vocational status and develop individualized plans of care
Communicate with members and stakeholders including providers, attorneys, employers, and insurance carriers
Prepare required case-work documentation
Consult with internal multidisciplinary teams
Contact treating physicians or specialists regarding care and treatment
Provide education and prevention information
Apply rehabilitation-services laws, regulations, insurer instructions, and referral-source requirements
Testify as required to substantiate case work or reports
Evaluate needs and benefit-plan eligibility using clinical tools and data
Monitor progress toward desired outcomes through assessment and evaluation
Develop proactive actions to improve short- and long-term health, wellness, medical outcomes, and return-to-work or optimal functioning

Requirements

What you’ll need

Registered and unrestricted Compact RN licensure
Minimum 3+ years clinical practical experience preferred in diabetes, CHF, CKD, post-acute care, hospice, palliative care, or cardiac care with Medicare members
Minimum 2+ years CM, discharge planning and/or home health care coordination experience
Associate's degree or Nursing Diploma required
Bachelor's degree preferred
Excellent analytical and problem-solving skills
Effective communication, organizational, and interpersonal skills
Ability to work independently
Proficiency with MS Word, Excel, Outlook, PowerPoint, and proprietary applications
Efficient computer skills, including navigating multiple systems and keyboarding
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
Quiet, secure, private, designated home workspace compliant with CVS Health and HIPAA guidelines
Ability to work within the state and city where currently living
Ability to use multiple monitors and applications simultaneously
Experience with Microsoft Office 365 applications or similar tools such as Google Workspace
Ability to use secure systems such as VPN and EHR portals
Ability to follow computer security practices, including strong passwords and recognizing suspicious emails or links
Ability to troubleshoot common technical issues
Certified Case Manager preferred
Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) preferred but not required

Benefits

Comp & perks

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.)
CVS Health bonus, commission or short-term incentive program in addition to base pay