Remote Clinical Case Manager Registered Nurse (RN) – Work‑From‑Home Telehealth & Crisis Intervention Role for CVS Health in Illinois (Chicago‑Area)
```html About CVS Health – A Purpose‑Driven Leader in Healthcare At CVS Health, we believe that health is a personal journey, and every interaction matters. Our purpose—“Bringing our heart to every moment of your health”—drives a culture where compassion meets innovation. From community pharmacies to advanced telehealth services, we continuously expand our reach to make care more convenient, affordable, and human‑focused. Joining our team means becoming part of an organization that invests in your growth, celebrates diverse perspectives, and empowers you to leave a lasting imprint on the health of our members across the United States. Why This Role Is a Game‑Changer This is more than a “clinical case manager” position; it is an opportunity to be the trusted advocate for members navigating complex health challenges. As a Remote Clinical Case Manager RN, you will blend clinical expertise, strategic problem‑solving, and heartfelt communication to ensure members receive the right care at the right time—whether through a phone call, video visit, or an in‑person meeting in the Chicago area. Key Responsibilities – Making a Direct Impact Every Day
- Comprehensive Member Assessment: Conduct thorough, evidence‑based evaluations of each member’s medical, behavioral, and psychosocial needs using standardized clinical tools and data analytics.
- Care Planning & Coordination: Develop individualized, goal‑oriented care plans that integrate provider recommendations, benefit eligibility, and community resources.
- Crisis Intervention: Rapidly identify and respond to medical or behavioral health crises, connecting members with emergency services, mental‑health specialists, or appropriate follow‑up care.
- Provider Collaboration: Serve as the liaison between members, primary care providers, specialists, and ancillary services, ensuring seamless communication and alignment on treatment plans.
- Utilization Management: Apply clinical guidelines and regulatory standards to review and authorize services, promoting cost‑effective, high‑quality care.
- Education & Coaching: Empower members through motivational interviewing and health‑literacy coaching, encouraging self‑management, lifestyle changes, and informed decision‑making.
- Quality Assurance & Documentation: Maintain meticulous records in compliance with CVS Health policies, accreditation requirements, and state/federal regulations.
- Team Participation: Present complex cases at multidisciplinary conferences, contribute insights, and collaborate on system‑wide improvement initiatives.
- Travel & Community Presence: Allocate up to 25% travel time to meet members face‑to‑face in the Chicago (Cook County) area and attend occasional training sessions in Downers Grove, IL.
Essential Qualifications – What You Bring to the Table
- Licensure: Active, unrestricted RN license in the state of Illinois.
- Clinical Experience: Minimum of 3 years of bedside or ambulatory nursing experience delivering direct patient care.
- Case Management Expertise: At least 2 years of formal case‑management responsibilities, with proven ability to navigate complex health plans.
- Discharge Planning: 1 + year of discharge planning experience, ensuring safe transitions from acute care to home or community settings.
- Crisis Intervention: Six months or more of hands‑on crisis management, including behavioral health emergencies.
- Technology Proficiency: Comfortable using multiple electronic health record (EHR) systems, telehealth platforms, and the Microsoft Office suite (Teams, Outlook, Word, Excel) for at least 2 years.
- Travel Readiness: Ability to travel up to 25 % of work time within Cook County, with reliable personal transportation (mileage reimbursed per policy).
- Schedule Commitment: Availability to work Monday‑Friday, 8:30 am–5:00 pm CST, adhering to scheduled shift requirements.
Preferred Qualifications – The Extra Edge
- Experience within a Managed Care Organization (MCO) or similar payer environment.
- Demonstrated mastery of time‑management and organizational strategies to handle shifting priorities.
- Strong independent judgment, coupled with the ability to make sound clinical decisions under pressure.
- Advanced critical‑thinking and problem‑solving capabilities, particularly when addressing multifactorial health issues.
- Exceptional verbal and written communication skills, enabling clear articulation of complex clinic