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.

Candidate must reside in a compact state 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 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.

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.