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.

Position Summary

This position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients.

Shift schedule is Monday – Thursday 8:30 am – 8:00 pm EST and Friday 8:30 – 5:00 PM EST – work an 8 hour shift .

Candidate will work these hours in their time zone.

This is a work at home position and all training is virtual.

Enhancement of Medical Appropriateness and Quality of Care:
- 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 to ensure appropriate administration of benefits.
- Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
- Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
- Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
-Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives.
- Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
- Identifies and escalates member's needs appropriately following set guidelines and protocols.
- Need to actively reach out to members to collaborate/guide their care.

- must have hard wired internet

Required Qualifications

5+ years’ experience as a Registered Nurse1+ years Nursing Management experience in patients with Diabetes, Cardiac Disease, ICU, CCU, Home Health or Pulmonary Disease.1+ years documenting electronically using keyboard and multiple computer screens--free form text/good typing skills and Microsoft Office applications especially Excel required. Must have active and unrestricted RN licensure in the state you reside. Compact Licensure RN License is required for this role.

Preferred Qualifications

1+ years current or previous experience in Home Healthand/or Case Management experience preferred. 1+ years experience with Lexicomp a plus.1+ years experience Motivational Interviewing a plus Certified Diabetes Care and Education Specialist (CDCES)Bilingual in Spanish preferred

Education

High School Diploma/Associates degree required.Bachelor’s preferred.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$60,522.00 - $142,576.00

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 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 08/28/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.