Case Manager, Registered Nurse – Illinois Medicare Advantage (Remote)
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
- Schedule: Standard business hours Monday-Friday 8:00am-5:00pm CST, no night, weekends, or holiday shifts.
Position Summary/Mission
Community Care Case Manager use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes.
Fundamental Components & Physical Responsibilities
- Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.
- Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care.
- Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services.
- Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate.
- Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person.
- Prepares all required documentation of case work activities as appropriate.
- Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes.
- May make outreach to treating physician or specialists concerning course of care and treatment as appropriate.
- Provides educational and prevention information for best medical outcomes.
- Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources.
- Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data.
- Utilizes case management processes in compliance with regulatory and company policies and procedures.
- Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work.
- Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes, as well as opportunities to enhance a member’s/client’s overall wellness through integration.
- Monitors member/client progress toward desired outcomes through assessment and evaluation.
Remote Work Expectations
- No travel required, candidates must have a dedicated workspace free of interruptions.
- Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.
Required Experience
- Registered Nurse with active state license in Illinois.
- Minimum 3+ years of clinical practical experience preference: (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members.
- Minimum 2+ years of case management, discharge planning, and/or home health care coordination experience.
Preferred Experience
- Bilingual preferred.
- Certified Case Manager is preferred.
- Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) is preferred, but not required.
- Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.
- Efficient and Effective computer skills including navigating multiple systems and keyboarding.
- Willing and able to obtain multi state RN licenses if needed, company will provide.
Education
- Associate's degree or Nursing Diploma Required.
- Bachelor’s degree Preferred.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$66,575.00 - $142,576.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.