Case Manager RN

CVS Health seeks a Case Manager RN to deliver telephonic and virtual care management for diverse patient populations. You will assess clinical needs, develop individualized care plans, coordinate services, and support safe, cost effective care across settings. Responsibilities include utilization review, discharge planning, and patient education on chronic conditions, medications, and community resources. You'll collaborate with providers, payers, and internal teams, document in EMR systems, and meet quality, regulatory, and productivity standards. CVS Health offers growth, inclusive culture, and competitive benefits.

Responsibilities

• Perform comprehensive clinical assessments via phone or virtual platforms
• Develop and update individualized care plans focused on quality and cost-effective outcomes
• Coordinate services across providers, facilities, and community resources
• Conduct utilization review and support appropriate level-of-care determinations
• Educate patients and caregivers on diagnoses, medications, and self-management
• Support discharge planning and smooth transitions of care
• Document accurately in EMR/EHR systems and maintain regulatory compliance
• Monitor outcomes, address gaps in care, and meet quality and productivity metrics

Required Skills

• Registered Nursing (RN)
• Clinical assessment
• Utilization review
• Care planning
• Chronic disease management
• EMR/EHR documentation
• Care coordination
• Motivational interviewing
• Health coaching
• Quality and compliance documentation