Case Manager RN- Field

Job DescriptionThis is a Case Manager RN role based near Fredericksburg, Virginia. Qualified candidates must reside in Fredericksburg, VA. Normal Working Hours: Monday through Friday 8am-5pm EST. The employee may have to occasionally flex hours earlier or later to accommodate members' needs.There are no weekends or holidays required.This Case Manager RN position consists of working intensely as a field case manager with patients and their care team for Joint Venture clients. The Case Manager RN will need a Virginia nursing license and will need to obtain a multi-state license upon hire (paid for by the company).The Case Manager RN position is work-from-home with travel required around 50-80% of the time which will involve face to face visits with members in Virginia as part of the Innovation Health component to the role. The employee will need to live near the northern Virginia areas of Fredericksburg, Virginia to realistically perform this function of the job. Occasional in-person meetings with Innovation Health in Virginia may also be required. The Case Manager RN role includes (not all encompassing):- Application and/or interpretation of 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 case management processes in compliance with regulatory and company policies and procedures.- 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.-Perform medical necessity reviewsRequired Qualifications- A Registered Nurse that must hold an active and unrestricted license in their state of residence, with multi-state/compact privileges and have the ability to be licensed in all non-compact states, including D.C. (paid for by the company).- 3+ years experience as a Registered Nurse required. - 1+ year experience documenting electronically in a medical record using a keyboard and multiple computer screens with an ability to type free-form text at an efficient pace.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications- Clinical experience preferred in either medical-surgical or home healthcare.- 1+ years Case Management experience - Managed Care Organization experience - Background in motivational interviewing, active listening skills techniques- Experience with MS Office Suites.- ATV and ASD experience.- Demonstrated ability to communicate, problem solve, and work effectively with people, use good judgment in challenging situations.Education- Associates Degree in Nursing required; BSN is preferred.Business OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. 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.

Created: 2025-10-04