Cvs Health Utilization Management Remote Jobs in New York

Location: Work at Home New York

Schedule: Mon-Fri 08:00-05:00 PM EST

The Case Manager RN is responsible for providing comprehensive care management services to members with complex medical, behavioral health, and social needs. The role includes conducting clinical assessments, developing and monitoring person-centered care plans, coordinating care across providers and community resources, facilitating transitions of care, identifying and addressing barriers to health outcomes, and ensuring members receive medically necessary and cost-effective services. The Case Manager RN collaborates with interdisciplinary teams, members, caregivers, and providers to promote quality outcomes, member satisfaction, regulatory compliance, and achievement of organizational goals.

• Active and unrestricted Registered Nurse (RN) license in the applicable state.
• Minimum of 3 to 5 years of clinical nursing experience, preferably in care management, case management, home care, long-term care, managed care, utilization management, or community-based healthcare settings.
• Experience coordinating care for members with complex medical, behavioral health, and psychosocial needs.
• Strong knowledge of chronic disease management, care coordination, and healthcare delivery systems.
• Ability to perform clinical assessments, identify member needs, and develop comprehensive care plans.
• Excellent communication, organizational, critical thinking, and problem-solving skills.
• Proficiency in Microsoft Office applications and electronic documentation systems.
• Ability to work independently while effectively collaborating with interdisciplinary teams.

• Certified Case Manager (CCM) certification or willingness to obtain certification.
• Experience working in Managed Long-Term Care (MLTC), Medicare, Medicaid, Dual Eligible, or other managed care populations.
• Knowledge and experience with the Uniform Assessment System (UAS-NY) and person-centered service planning.
• Experience coordinating home and community-based services (HCBS), long-term services and supports (LTSS), and behavioral health services.
• Bilingual skills preferred.
• Experience working in a remote or field-based care management environment

• Bachelor's Degree in Nursing (BSN) preferred.
• Current, unrestricted Registered Nurse (RN) license required.
• Additional certifications in Case Management, Care Coordination, Utilization Management, or related specialties are preferred.

• You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and
• A minimum download speed of 25 mbs download and 3 mbs upload. Wi-Fi and satellite internet are not permitted.
• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS
• Health and HIPAA guidelines and allowing for uninterrupted work during work hours.
• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
• The company will provide equipment (keyboard, monitor, computer, headset, etc.).
• All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
• If hired, you will commit to obtaining required internet speeds and adhere to all Work from Home requirements.

• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
• Collaboration & Scheduling:
• Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
• Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
• Troubleshooting & Support: Ability to resolve common technical issues independently, such as restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
• Future Growth: Openness to learning new skills in the future as the workplace environment evolves