Case Manager Registered Nurse

$60,522 - $129,615 / year

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. Schedule: Monday-Friday 8:00 AM - 5:00 PM Eastern Position Summary Help us elevate our patient care to a whole new level! Join our Community Care team as an industry leader in serving our members by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Community Care members. Community Care is a member centric, team-delivered, community-based care management model that joins members where they are. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country. Family Summary/Mission Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements, and supports Health Strategies, tactics, policies, and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies. Position Summary/Mission Community Care Case Manager use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes. Fundamental Components & Physical Requirements • Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. • Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. • Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services. • Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate. • Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person. • Prepares all required documentation of case work activities as appropriate. • Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes. • May make outreach to treating physician or specialists concerning course of care and treatment as appropriate. • Provides educational and prevention information for best medical outcomes. • Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources. • Testifies as required to substantiate any relevant case work or reports. • Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data. • Utilizes case management processes in compliance with regulatory and company policies and procedures. • Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work. • Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes, as well as opportunities to enhance a member’s/client’s overall wellness through integration. • Monitors member/client progress toward desired outcomes through assessment and evaluation. Required Qualifications Active Registered Nurse Compact License Minimum 3+ years clinical practical experience preference: (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members Minimum 2+ years CM, discharge planning and/or home health care coordination experience Preferred Qualifications Previous Utilization Management experience, transitions of care and discharge planning Ability to occasionally travel within a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs arise Excellent analytical and problem-solving skills Effective communications, organizational, and interpersonal skills. Ability to work independently (may require working from home). Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications. Efficient and Effective computer skills including navigating multiple systems and keyboarding Willing and able to obtain multi state RN licenses if needed, company will provide. Certified Case Manager is preferred. Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) is preferred, but not required Education Associates Degree in Nursing with equivalent experience Bachelor’s in Science and Nursing preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $60,522.00 - $129,615.00 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: 04/13/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

RN

Full-time

1 week ago

RN Nurse Navigator - Medical Administration - FT

Highmark Health PA

$33.11 - $54.25 / hour

Company : Allegheny Health Network Job Description : We are seeking an individual with exceptional communication skills who is adept at engaging with high-level executives and building strong professional connections across our network GENERAL OVERVIEW: Serves as the consistent point of contact for referring physicians, patients, caregivers, families, and the community. Facilitates patient flow, including coordination of appointments and assists the patient with accessing clinical and supportive care services within the Network. The RN Nurse Navigator coordinates all aspects of care in collaboration with the multidisciplinary team for all adult patients within specialized disease state to ensure they receive quality and comprehensive services. Identifies community needs and provides education, screening, support, referrals, coordination of care, and any other assistance identified as necessary. ESSENTIAL RESPONSIBILITIES: Oversees community outreach, high risk populations and disease specific sites to establish and sustain working relationships within the network (health plan, physicians, office staff, social services staff, financial counselor, dietician, etc.). Educates and coordinates care regarding patient's diagnosis, treatment options, course of treatment, clinical trial information and resources available. Works with health care team to ensure safe handoff, coordination of care between facilities as well as inpatient to outpatient or outpatient to inpatient coordination of care. Works with High-Risk Care Teams to reduce re-admissions. May work with and/or assist Registry staff with data collection, patient outcomes and updates care delivery models. Coordinates appointments including all aspects of the multi-disciplinary team (physicians, consults, supportive care services, etc. and accompanies patients as needed to appointments. Ensures that medication adherence issues are addressed. Works with AHN physician offices/facilities to identify at-risk patients and assists in facilitating appropriate screening processes. Trends data and outcomes as established for the navigation program. Identifies gaps to improve patient care across the continuum. Develops or attends an existing clinical care conference to report out on active patients to the multidisciplinary team. May identify bereavement needs of families and develop plan of care. Performs other duties as assigned or required. QUALIFICATIONS: Minimum Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) 1-3 year(s) nursing experience in the specialty required. CPR – American Heart Association Act 34 Criminal Background Clearance Certificate Act 33 Child Abuse Clearance Certificate Act 73 FBI Fingerprinting Criminal Background Clearance Certificate Preferred Bachelor's Degree in Nursing Certification in area of expertise. Valid PA driver's license may be required. Older Adults Protective Services Act (OAPSA) clearance may be required depending on location. Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $33.11 Pay Range Maximum: $54.25 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice

RN

Full-time

1 week ago

Case Manager Registered Nurse

CVS Health PA

$60,522 - $129,615 / year

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. Position Summary This Case Manager RN position is 100% remote and the employee can live in any state. Normal Working Hours: 8:00am through 4:30pm in time zone of residence. No travel is expected with this position. The Case Manager RN utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. The Case Manager RN process includes assessing the member's health status and care coordination needs, inpatient review, and discharge planning, developing, and implementing the case management plan, monitoring, and evaluating the plan and involving the Medical Director as indicated and closing the case as appropriate when the member has met discharge criteria. The Case Manager RN role requires a nurse that can exercise independent and sound judgment and someone that has strong decision-making skills and well-developed interpersonal skills. The Case Manager RN is expected to manage multiple priorities, demonstrate both effective organizational and time management skills as well demonstrate strong teamwork skills. The responsibilities of this Case Manager RN position are to: -Apply data driven methods of identification of members to fashion individualized case management programs and/or referrals to alternative healthcare programs. -Conduct comprehensive clinical assessments. -Evaluate needs and develop flexible approaches based on member needs, benefit plans or external programs/services. -Advocate for patients to the full extent of existing health care coverage. -Promote quality, cost effective outcomes, and make suggestions to improve program/operational efficiency. -Identify and escalate quality of care issues through established channels. -Provide an expected very high level of customer service. -Utilize assessment techniques to determine member’s level of health literacy, technology capabilities, and/or readiness to change. -Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health. -Provide coaching, information, education, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices Required Qualifications - Must have active, current and unrestricted RN licensure in state of residence - Willingness and ability to obtain additional state licenses upon hire (paid for by the company) - 3+ years of acute hospital clinical experience as an RN (general medical, post-surgical, ER, ICU experience). - 3+ years of experience with all types of Microsoft Office including PowerPoint, Excel, and Word - Must be able to work Monday through Friday, 8:00am to 4:30pm in time zone of residence Preferred Qualifications -Compact RN License -Certified Case Manager (CCM) -Managed Care experience -Home Care experience -Telephonic case management and/or telephonic customer service center experience Education Associate Degree in Nursing with RN licensure required; BSN preferred. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $60,522.00 - $129,615.00 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: 03/21/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

MDS Coordinator

Epic Healthcare Springfield Township, PA

NOW HIRING: MDS Coordinator Location: Philadelphia Are you an organized and detail-oriented professional with experience in MDS coordination ? Our healthcare facility in Philadelphia is seeking an MDS Coordinator to join our team and contribute to the smooth operation of our long-term care facility. Position Overview: As the MDS Coordinator , you will play a crucial role in ensuring accurate and compliant documentation related to resident assessments. Your work will assist in providing the highest level of care and support to our residents. Benefits: Competitive compensation and benefits package. Supportive work environment. Opportunities for professional development. Join our team and make a difference in resident care. Key Responsibilities: Manage MDS documentation. Collaborate with the nursing and administrative teams. Ensure MDS compliance. Assist in quality improvement initiatives. Maintain accurate resident records. Qualifications: Previous experience as an MDS Coordinator in PA. Knowledge of MDS documentation and compliance. Strong organizational skills. Attention to detail. Effective communication skills. Join our team in Philadelphia , and help us maintain accurate and compliant resident records while contributing to the overall quality of care in our facility. Your attention to detail and coordination skills are vital to our success.

RN

Full-time

2 months ago

Registered Nurse (RN) Clinical Consultant

Long Term Healthcare Facility PA

Prestige Healthcare Administrative Services is hiring a Full Time Regional Clinical Consultant that will support the following areas: Columbia and Bucks County in PA. This position requires a RN License valid in the state of PA. The Clinical Nurse Consultant will be responsible to facilitate healthcare services and review outcomes in an effort to improve patient care. The individual will assist with facilitating changes in practices, professional development and enhance management policies to promote professional standards of care. Must have extensive clinical knowledge of requirements in skilled nursing facility to support the facility’s care and services. The clinical nurse consultant must be compassionate, possess good communication skills and an advocate for patient’s best interests. ESSENTIAL DUTIES AND RESPONSIBILITIES: · Ensures that the facility is in compliance with Federal and PA regulations as well as the organization’s policy and procedures. · Conducts audits of the facility's systems and evaluates for survey readiness, compliance with Medicare requirements and optimal quality of care for each resident. · Performs regular review of Electronic Medication Administration Records (EMAR), Point of Care (POC), Point Click Care (PCC) to ensure compliance. · Regularly monitors wound care program in order to promote quality outcomes provided in the facilities to ensure appropriateness and effectiveness. · Reviews Risk management portal to ensure that incident investigation and follow up are completed timely. incident reports and follow up notes regularly to ensure state reportable incidents are being reported, proper procedure is being followed and documented. · Facilitates company policies and procedures related to patients and employees · Attends QAPI, monthly Infection Control, weight and psychotropic meetings · Ability to support the Director of Nursing and Administrator with day-to-day operations · Provides mentoring and support for facility administrative staff and assists with problem solving as needed · Reviews medical records prior to any legal requests for documents · Attends meetings as required; works cooperatively with members of the management and care team, maintaining effective interdepartmental and interpersonal relations with residents, staff, and visitors. · Assist in hiring, training, planning assigning and directing the work of facility staff as needed. · Conducts audits including resident charts, medication room and QA interventions. · Performs comprehensive assessment on residents. QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements below are representative of the knowledge, skill, and/or ability required. · Bachelor’s Degree in Nursing required. · Five years management experience with experience in long-term care; Previous experience as a Director of Nursing Services (DON) preferred · Must possess a current, unencumbered, active license to practice as an RN in Pennsylvania) · Proficient in communication and writing skills · Must have a valid driver’s license., position requires travel · General knowledge of professional basic nursing, restoratives and personal care services. · Ability to read, and interpret documents, write reports, and correspondence and possess · High level of interpersonal skills to handle sensitive and confidential situations and documentation, and interaction with coworkers. The clinical nurse consultant will report to the Regional Clinical Consultant. PHYSICAL DEMANDS: The physical demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. · Must be able to move intermittently throughout the workday. · Must be able to push, pull move and/or lift a minimum of 50 pounds to a minimum height of 5 feet and be able to push, pull, move and/or carry such weight a minimum distance of 50 feet. · The noise level in the work environment is usually moderate . · Ability to travel within the assigned region, up to 75%. We offer a comprehensive salary and benefits package to include medical, dental, vision, PTO, 401K, Bonus Plan, and much more. #PH2024

Registered Nurse Full Time Evening

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