# Registered Nurse Case Manager

**Company**: American Health Holding, Inc (AHH)
**Location**: Work from home, TX
**Work arrangement**: remote
**Experience**: senior
**Job type**: full-time
**Salary**: $54,095.00 - $155,538.00
**Category**: Healthcare
**Industry**: Healthcare

**Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/TX---Work-from-home/Case-Manager--Registered-Nurse--Oncology-experience-required-_R1040362-1?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_57ce8621-3bb

## Description

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.

This is a remote work from home role anywhere in the US with virtual training.

**Position Summary** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members.

**Key Responsibilities**

- Work intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients.

- Apply and interpret applicable criteria and clinical guidelines, standardized care management plans, policies, procedures and regulatory standards while assessing benefits and/or member's needs.

- Use clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.

- Conduct assessments utilizing information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.

- Consult with supervisor and others in overcoming barriers in meeting goals and objectives, present cases at case conferences for multidisciplinary focus to benefit overall claim management.

- Use a holistic approach to consult with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives.

- Utilize case management processes in compliance with regulatory and company policies and procedures.

- Use motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs.

- Identify and escalate member's needs appropriately following set guidelines and protocols.

- Actively reach out to members to collaborate/guide their care.

- Perform medical necessity reviews.

**Required Qualifications**

- 5+ years' experience as a Registered Nurse, including at least 1 year in a hospital setting.

- The AHH RN Case manager position requires the nurse to support members across multiple states. A RN who resides in a compact state is required to have an active multistate license through the Nurse Licensure Compact (NLC), allowing practice across participating states with one license.

- 1+ years' experience documenting electronically using a keyboard.

- 1+ years' current or previous experience in Oncology.

**Preferred Qualifications**

- 1+ years' Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience.

- 1+ years' experience in Utilization Review.

- CCM and/or other URAC recognized accreditation preferred.

- 1+ years' experience with MCG, NCCN and/or Lexicomp.

- Bilingual in Spanish preferred.

- BSN Preferred.

**Education**

- Diploma or Associates Degree in Nursing required.

**Anticipated Weekly Hours** 40

**Time Type** Full time

**Pay Range** $54,095.00 - $155,538.00

**Benefits** We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.

## Skills

### Required
- Registered Nurse
- Case Management
- Disease Management
- Utilization Management
- Oncology

### Nice to have
- Case Management experience
- Discharge planning
- Nurse navigator
- Nurse care coordinator
- Utilization Review
- CCM
- URAC
- MCG
- NCCN
- Lexicomp
- Spanish
- BSN

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Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/TX---Work-from-home/Case-Manager--Registered-Nurse--Oncology-experience-required-_R1040362-1?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)