Case Manager Registered Nurse (Remote, WV)

$54,095 - $116,760 / 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.

Job Summary:

The Care Manager—Registered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible for coordinating care for members who often face multiple chronic medical and behavioral health conditions, as well as various social determinants of health (SDoH) needs. This role involves conducting comprehensive assessments to evaluate members’ needs and addressing SDoH challenges by connecting them with appropriate resources and support services. The Social Worker provides education and guidance to members and their families on managing chronic conditions and navigating the healthcare system. Additionally, the Care Manager develops and implements individualized care plans, monitors member progress, advocates for necessary services, and collaborates with the interdisciplinary care team to ensure optimal health outcomes. Accurate and timely documentation of assessments and interventions is essential, as is participation in team meetings to discuss member status and care strategies.

Key Responsibilities:

50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care.
Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member’s identified needs.
Provides evidence-based disease management education and support to help the member achieve health goals.
Ensure the appropriate members of the interdisciplinary care team are involved in the member’s care.
Provides care coordination to support a seamless health care experience for the member.
Meticulous documentation of care management activity in the member’s electronic health record.
Collaborate with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition.
Identifies and connects members with health plan benefits and community resources.
Meets regulatory requirements within specified timelines.
The Care Manager RN supports other members of the Care Team through clinical decision making and guidance as needed.
Additional responsibilities as assigned by leadership to support team objectives, enhance operational efficiency, and ensure the delivery of high-quality care to members. This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members.

Essential Competencies and Functions:

Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements of this role.
Conduct oneself with integrity, professionalism, and self-direction.
Experience or a willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care.
Familiarity with community resources and services.
Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records.
Maintain strong collaborative and professional relationships with members and colleagues.
Communicate effectively, both verbally and in writing.
Excellent customer service and engagement skills.

Required Qualifications

Must have active and unrestricted Registered Nurse (RN) licensure in the state of X OR compact licensure in state of residence
Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the CM RN role.
Access to a private, dedicated space to conduct work effectively to meet The requirements of the position.
Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually.
Minimum 3+ years of nursing experience
Minimum 2+ years of case management, discharge planning and/or home healthcare coordination experience

Preferred Qualifications

Experience providing care management for Medicare and/or Medicaid members.
Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health.
Experience conducting health-related assessments and facilitating the care planning process.
Bilingual skills, especially English-Spanish

Education

Associate’s of Science in Nursing (ASN) degree and relevant experience in a health care-related field (REQUIRED)
Bachelor’s of Science in Nursing (BSN) (PREFERRED)

License

Must have active and unrestricted Registered Nurse (RN) licensure in the state of WV OR compact licensure in state of residence

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,095.00 - $116,760.00

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: 02/27/2026

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

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The CAPE program is a system-wide clinical advancement program (clinical ladder) to enhance professional development, provide a reward system for quality clinical performance, promote quality nursing, and improve job satisfaction for inpatient direct care nurses. To apply for the next level, the CAPE nurse must meet the requirements of their current level. They must also meet the required years of nursing experience, degree, and certification to apply for the next level. In addition, nurses who are approved for levels 3, 4, 5, or 6 must complete and submit five competencies on an annual basis to maintain their current level. Level 1 No experience required All graduate nurses with less than 12 months of experience enter at Level one with a diploma, ADN, BSN, or higher Level 2 Meets requirements for previous level One year of experience. Level 3 Meets requirements for previous levels Two years of experience, plus one specialty certification Certification is Preferred but not required Required competencies to include demonstration of regularly being a charge nurse and/or precepting new staff or nursing students Level 4 Available to those with a BSN or higher or nurses with ADN/diploma with 5 years of experience one specialty certification is required Required competencies to include demonstration of regularly being a charge nurse and/or precepting new staff or nursing students Required competencies to include demonstration of participation in QI and/or shared governance at the unit level Level 5 Available to those with an MSN or higher with 4 years of experience, or nurses with a BSN with 4 years of experience and a health-related Master’s Degree, or nurses with a BSN and 5 years of experience One specialty certification is required Required competencies to include demonstration of regularly being a charge nurse and/or precepting new staff or nursing students Required competencies to include demonstration of participation in QI and shared governance at the organization level Level 6 Available to those with an MSN or higher degree with 7 or more years of experience. Consideration is given to other health-related advanced degrees that would assist with direct patient care at the bedside One specialty certification is required Required competencies to include demonstration of regularly being a charge nurse and/or precepting new staff or nursing students Required competencies to include demonstration of participation in QI and shared governance at the system level Additional Job Description: Scheduled Weekly Hours: 36 Shift: Varied (United States of America) Exempt/Non-Exempt: United States of America (Non-Exempt) Company: UHA University Health Associates Cost Center: 200 WVUH Cardiopulmonary Services Address: 1 Medical Center Drive Morgantown West Virginia Equal Opportunity Employer University Health Associates and its subsidiaries (collectively "UHA") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. UHA strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All UHA employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.

Full-time

RN-Nights-Acute

apartment Summit BHC location_onCharleston, WV

$36 - $46 / hour

RN-Nights-Acute | Highland Hospital | Charleston, West Virginia About the Job: The Registered Nurse is responsible for providing nursing care to patients. Supervising care treatment and services of patient care provided by LPNs, CNAs and other staff on assigned unit and shift. Developing, implementing, and evaluating an individual plan of care for each patient. Assessment and re-assessment of patients. Communicating appropriate information with the interdisciplinary team. Reporting patient concerns and changes in condition to supervisor and/or physician in a timely manner. Roles and Responsibilities: ** STARTING PAY $36-$46 ** SHIFT DIFFERENTIAL $4.60-$6.35 ** ESSENTIAL FUNCTIONS: · Provides and coordinates care by assessing physical and behavioral health needs of patient, develops and implements nursing care plans, maintains medical records and educates patients and their families about various physical and behavioral health conditions while ensuring patient safety at all times. · Assesses patient’s status on an ongoing basis and pertinent information gathered is documented. · Ensures nursing treatment plans are specific to assessed needs and initial treatment plan is completed upon admission. · Takes physician’s orders (verbal or via telephone) accurately and documents appropriately; transcribes and reviews physician’s orders. Ensures physician’s orders are legible if taken verbally and transcribed appropriately per policy and procedure. · Accurately administers medications per ordered note and documents accurate count of controlled substance. Adjusts medications under provider’s supervision as needed; monitors lab results to validate medication compliance. · Notifies physician of significant changes in status such as difficulties with detox, medical emergency or change in medical status regarding response to medications, etc. · Supervises self-administration of medications using safety initiative of using two means of patient identification: documents and reports effects of scheduled and PRN medications. · Maintains accountability of administration, recording, control and security of medications, including narcotics. · Completes admission and discharge processes efficiently and accurately as directed. · Confers regularly with treatment team (e.g., nurses, therapists, program managers, physician) regarding patient care. Attends and participates in the unit activities such as therapy groups, family meetings as appropriate, staffing, unit meetings, etc. · Provides education/explanation to patients, families, and co-workers regarding medication usage/maintenance, common side effects, patient's rights, as well as other topics necessary for optimal patient care. · Monitors patient acuity, census, staffing needs, and makes arrangements for coverage as needed, following established guidelines. · Assures thorough, accurate documentation is completed for all patients on each shift and patient assignment sheets are completed daily and tasks are carried out as assigned. · Gives thorough report to oncoming staff, supervisors, and physician. · Provides coverage in emergency services as needed. EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: · Graduation from an approved/accredited school of nursing. · One or more years’ nursing experience within clinical area of service provided by facility preferred. · Experience in behavioral health/psychiatric/addiction recovery environment preferred. LICENSES/DESIGNATIONS/CERTIFICATIONS: · Valid current RN license from the state or from a compact state, where applicable. · Certified in Psychiatric Nursing preferred. · CPR and de-escalation and restraint certification required (training available upon hire and offered by facility). · First aid may be required based on state or facility requirements. Why Highland Hospital?Highland Hospital offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume. Highland Hospital is an EOE. Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.