Remote Clinical Case Manager Registered Nurse (...

```html About CVS Health – A Purpose‑Driven Leader in Healthcare At CVS Health, we believe that health is a personal journey, and every interaction matters. Our purpose— “Bringing our heart to every moment of your health” —drives a culture where compassion meets innovation. From community pharmacies to advanced telehealth services, we continuously expand our reach to make care more convenient, affordable, and human‑focused. Joining our team means becoming part of an organization that invests in your growth, celebrates diverse perspectives, and empowers you to leave a lasting imprint on the health of our members across the United States. Why This Role Is a Game‑Changer This is more than a “clinical case manager” position; it is an opportunity to be the trusted advocate for members navigating complex health challenges. As a Remote Clinical Case Manager RN, you will blend clinical expertise, strategic problem‑solving, and heartfelt communication to ensure members receive the right care at the right time—whether through a phone call, video visit, or an in‑person meeting in the Chicago area. Key Responsibilities – Making a Direct Impact Every Day Comprehensive Member Assessment: Conduct thorough, evidence‑based evaluations of each member’s medical, behavioral, and psychosocial needs using standardized clinical tools and data analytics. Care Planning & Coordination: Develop individualized, goal‑oriented care plans that integrate provider recommendations, benefit eligibility, and community resources. Crisis Intervention: Rapidly identify and respond to medical or behavioral health crises, connecting members with emergency services, mental‑health specialists, or appropriate follow‑up care. Provider Collaboration: Serve as the liaison between members, primary care providers, specialists, and ancillary services, ensuring seamless communication and alignment on treatment plans. Utilization Management: Apply clinical guidelines and regulatory standards to review and authorize services, promoting cost‑effective, high‑quality care. Education & Coaching: Empower members through motivational interviewing and health‑literacy coaching, encouraging self‑management, lifestyle changes, and informed decision‑making. Quality Assurance & Documentation: Maintain meticulous records in compliance with CVS Health policies, accreditation requirements, and state/federal regulations. Team Participation: Present complex cases at multidisciplinary conferences, contribute insights, and collaborate on system‑wide improvement initiatives. Travel & Community Presence: Allocate up to 25% travel time to meet members face‑to‑face in the Chicago (Cook County) area and attend occasional training sessions in Downers Grove, IL. Essential Qualifications – What You Bring to the Table Licensure: Active, unrestricted RN license in the state of Illinois. Clinical Experience: Minimum of 3 years of bedside or ambulatory nursing experience delivering direct patient care. Case Management Expertise: At least 2 years of formal case‑management responsibilities, with proven ability to navigate complex health plans. Discharge Planning: 1 + year of discharge planning experience, ensuring safe transitions from acute care to home or community settings. Crisis Intervention: Six months or more of hands‑on crisis management, including behavioral health emergencies. Technology Proficiency: Comfortable using multiple electronic health record (EHR) systems, telehealth platforms, and the Microsoft Office suite (Teams, Outlook, Word, Excel) for at least 2 years. Travel Readiness: Ability to travel up to 25 % of work time within Cook County, with reliable personal transportation (mileage reimbursed per policy). Schedule Commitment: Availability to work Monday‑Friday, 8:30 am–5:00 pm CST, adhering to scheduled shift requirements. Preferred Qualifications – The Extra Edge Experience within a Managed Care Organization (MCO) or similar payer environment. Demonstrated mastery of time‑management and organizational strategies to handle shifting priorities. Strong independent judgment, coupled with the ability to make sound clinical decisions under pressure. Advanced critical‑thinking and problem‑solving capabilities, particularly when addressing multifactorial health issues. Exceptional verbal and written communication skills, enabling clear articulation of complex clinical information to diverse audiences. BSN degree (required) with consideration for advanced certifications such as CNE, CCM, or RN‑BC (preferred). Core Skills & Competencies – Foundations for Success Clinical Judgment: Ability to interpret clinical data, apply evidence‑based guidelines, and make nuanced care decisions. Motivational Interviewing: Proven techniques for fostering member engagement and encouraging sustainable behavior change. Interpersonal Influence: Skillful at advocating for members with physicians, specialists, and external partners. Data Analysis: Comfortable synthesizing utilization metrics, self‑report surveys, and clinical outcomes to identify trends and gaps. Regulatory Acumen: Knowledge of HIPAA, HEDIS, CMS, and state‑specific regulations governing case management and telehealth. Technology Savvy: Proficient in navigating multiple systems simultaneously, troubleshooting technical issues, and leveraging digital tools for remote collaboration. Career Growth & Learning Opportunities CVS Health is committed to lifelong learning. As a Remote Clinical Case Manager RN, you will have access to: Continuing Education: Tuition reimbursement, free online courses, and professional development webinars. Certification Support: Financial assistance and study time for certifications such as Certified Case Manager (CCM) or Certified Nursing Executive (CNE). Mentorship Programs: Pairing with senior clinical leaders to accelerate skill‑building and career progression. Leadership Pathways: Clear routes to roles such as Senior Case Manager, Clinical Operations Manager, or Regional Director of Care Coordination. Cross‑Functional Projects: Opportunities to participate in enterprise‑wide initiatives focused on quality improvement, population health, and digital health innovation. Work Environment & Culture – What It Means to Be a CVS Health Colleague Even though this role is remote, you’ll be part of a vibrant, collaborative community: Heart at Work Behaviors: A set of values that encourages empathy, accountability, and a relentless focus on member‑centric care. Flexible Remote Setup: Home‑office stipend, ergonomic equipment recommendations, and IT support to ensure a productive workspace. Diversity & Inclusion: A culture that celebrates varied perspectives, with employee resource groups (ERGs) dedicated to fostering belonging. Team Connectivity: Regular virtual huddles, monthly town‑halls, and regional meet‑ups in Downers Grove to strengthen relationships. Recognition Programs: Peer‑to‑peer awards, performance bonuses, and “Heart‑of‑Service” accolades that highlight extraordinary contributions. Compensation, Perks, & Benefits – A Holistic Rewards Package CVS Health offers a competitive salary range of $66,575 – $142,577 annually, reflecting experience, education, and geographic factors. In addition to base pay, you may be eligible for performance‑based bonuses, commission structures, and short‑term incentives. Our comprehensive benefits suite includes: Medical, dental, and vision coverage with multiple plan options. Employer‑matched 401(k) retirement savings plan. Employee Stock Purchase Plan (ESPP) for eligible participants. Fully‑paid term life insurance, short‑term and long‑term disability protection. Generous paid time off (PTO), paid holidays, and sick leave in accordance with state law. Well‑being programs such as mental‑health counseling, fitness‑class reimbursements, and nutrition resources. Education assistance for advanced degrees, certifications, and professional courses. Exclusive CVS store discounts and partner‑program savings. Application Timeline & Next Steps We are reviewing applications on a rolling basis, with a target closing date of January 31, 2025 . If you meet the qualifications and are ready to bring your heart to CVS Health, we encourage you to submit your resume, cover letter, and any relevant certifications as soon as possible. Join Us – Make a Difference Today At CVS Health, your expertise will directly influence the health trajectories of thousands of members across Illinois. This is your chance to blend clinical mastery with compassionate advocacy, all while enjoying the flexibility of a remote career. Take the next step toward a rewarding future—apply now and become a cornerstone of our mission to deliver heartfelt, high‑quality care. Submit Your Application Seize this opportunity to make a significant impact. today. ``` Apply for this job