Case Manager Registered Nurse – Work at Home

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.

The Nurse Case Manager is responsible for delivering comprehensive case management services through telephonic and/or face-to-face interactions. This role involves assessing, planning, implementing, and coordinating care strategies to support members' medical needs and promote overall wellness. The Nurse Case Manager utilizes clinical judgment and data-driven tools to evaluate member eligibility, identify health risks, and develop proactive care plans that address both short- and long-term health outcomes.

Key responsibilities include conducting holistic assessments that consider co-morbid conditions, functional limitations, and social determinants of health. The Nurse Case Manager reviews prior claims, evaluates work capacity, and determines the need for referrals to clinical resources. Collaboration with supervisors and multidisciplinary teams is essential to overcome barriers and optimize care planning. This role operates within established regulatory and organizational policies, applying case management processes and service strategies that align with network management and clinical coverage guidelines. Strong interviewing and engagement skills are critical to understanding member needs and facilitating smooth transitions to appropriate programs and services.