Case Manager, Registered Nurse - Fully Remote

Telephonic Case Manager At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. This is a remote work from home role anywhere in the US with virtual training. American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members. Key Responsibilities • Working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients. • Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, policies, procedures and regulatory standards while assessing benefits and/or member's needs. • Incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators. • Assessments utilizing information from various sources to address all conditions. • Consulting with supervisor and others in overcoming barriers to meeting goals and objectives. • Utilizing case management processes in compliance with regulatory and company policies and procedures. • Utilizing motivational interviewing skills to ensure maximum member engagement. • Identifying and escalating member's needs appropriately. • Actively reaching out to members to collaborate/guide their care. • Performing medical necessity reviews. Required Qualifications • 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital setting. • A Registered Nurse that holds an active, unrestricted license in their state of residence, and willingness to receive a multi-state/compact privileges. • 1+ years' experience documenting electronically using a keyboard. • 1+ years' current or previous experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/Substance Abuse or Maternity/Obstetrics experience. Preferred Qualifications • 1+ years' Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience as well as experience with transferring patients to lower levels of care. • 1+ years' experience in Utilization Review. • CCM and/or other URAC recognized accreditation preferred. • 1+ years' experience with MCG, NCCN and/or Lexicomp. • Bilingual in Spanish preferred. Education • Diploma or Associates Degree in Nursing required. • BSN preferred. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $54,095.00 - $155,538.00 Great Benefits for Great People We take pride in our comprehensive and competitive mix of pay and benefits investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: • Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. • Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. This job does not have an application deadline, as CVS Health accepts applications on an ongoing basis. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. Apply tot his job