Telehealth Nurse Case Manager

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.

As a Nurse Case Manager, you will play a crucial role in providing healthcare support, care coordination and/or case management to members enrolled in a comprehensive healthcare program. Your expertise in nursing and healthcare management will be instrumental in assessing individuals' health needs, providing education and resources, and empowering them to make informed decisions about their health following a hospitalization, Emergency Department discharge, and/or a change to a higher level of acuity.  

SCOPE: Concierge Clinical Ops Case Managers, Triage Case Managers 

 PRIMARY DUTIES AND RESPONSIBILITIES:    

Clinical Assessments  

• Conduct comprehensive health assessments of members enrolled in healthcare programs through telephonic and/or digital tool interactions. 
• Gather relevant medical, social, and lifestyle information to develop a holistic understanding of each member’s current status. 
• Identify potential key risks, gaps in care, and opportunities for enhancing well-being. 

Education and Coaching 

• Provide telephonic and/or digital education, nursing interventions, and coaching to members on various health topics, including chronic disease management, preventive care, and healthy lifestyle choices. 
• Empower members to take an active role in managing their health by providing them with the knowledge and tools needed. 
• Collaborate with members to set achievable health goals and develop personalized action plans. 

Care Coordination and Referrals 

• Coordinate with healthcare providers and community resources to facilitate access to necessary services and support. 
• Facilitate referrals to internal multidisciplinary care team members including Health Management Nurses and Resource Specialists.  
• Assist members in navigating the healthcare system, including understanding insurance coverage and finding appropriate providers and resources. 

Health Monitoring and Follow-up 

• Regularly monitor individuals' health status and progress towards their health goals through telephonic and/or digital tool check-ins. 
• Provide ongoing support, encouragement, and accountability to individuals to help them stay on track with their health management plans. 
• Collaborate with healthcare providers to ensure continuity of care and timely interventions when necessary. 

    Documentation Reporting 

• Maintain accurate and up-to-date documentation of telephonic and/or digital tool interactions, assessments, care plans, and outcomes. 
• Ensure compliance with privacy and confidentiality regulations, including HIPAA guidelines. 
• Ensure adherence to quality benchmarks and standards in all documentation, maintaining accuracy, clarity, and compliance with organizational guidelines. 
• Demonstrate timely completion of case management activities in alignment with organizational protocols and NCQA accreditation standards, including documentation, care planning, and follow-up within required timeframes. 
• Perform additional duties as assigned based on the evolving needs of the business. 

                       
                        WORK SCHEDULE: This is a Monday thru Friday work schedule: 8 am to 5 pm your time zone with on flex day per week, 12 pm to 9 pm OR split flex 9 am to 1 pm and 5 pm to 9 pm your time zone.

EDUCATION: 

            RN Diploma, Associates or Bachelor’s in nursing 

REQUIRED SKILLS:   

• Registered Nurse (RN) licensure with a minimum of 3 years of clinical experience. 
• Aptitude for computer skills, proficiency with Microsoft and web-based applications. 
• Experience in health management, care coordination, or telephonic nursing is preferred. 
• Strong clinical knowledge and understanding of chronic diseases, preventive care, and health promotion. 
• Excellent communication and interpersonal skills, with the ability to engage individuals over the phone and build rapport. 
• Demonstrate utmost level of professionalism in all work interactions  
• Empathetic and patient-centered approach to care, with a focus on empowering individuals to take control of their health. 
• Ability to understand and explain complex medical information in a clear and understandable manner. 
• Strong organizational and time management skills, with the ability to prioritize tasks and manage a caseload effectively. 
• Proficiency in using telehealth platforms and digital technology for individualized member monitoring which may include toggling between multiple applications during member calls 
• Ability to handle both inbound and outbound calls providing timely and accurate nursing support and guidance as needed. 
• Ability to multitask while working independently and collaboratively in a remote and fast-paced environment. 
• Commitment to ongoing professional development and staying updated on the latest healthcare trends and guidelines. 
• Certified Case Manager Certification, CCM, strongly preferred.  If candidate does not currently hold certification, they must obtain within 4 years of employment. 
• A Registered nurse must hold an unrestricted license in their state of residence, with multi-state compact privileges and have the ability to be licensed in all non-compact states, territories and the District of Columbia based on the needs of the business.

Preferred Qualifications:

• Certified Case Manager Certification is a plus
• Previous telephonic/telehealth experience in health care
• Epic software experience

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This 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.