Case Manager, Registered Nurse – Oncology Experience Required

CVS Health

Case Manager, Registered Nurse position managing telephonic case management for oncology patients. Join CVS Health's mission to provide compassionate healthcare as part of a supportive team.

Posted 5/24/2026full-timeRemote • Texas • 🇺🇸 United StatesMid-LevelSenior💰 $54,095 - $155,538 per yearWebsite

About the role

Key responsibilities & impact

working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients
application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, policies, procedures and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits
applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues
assessments utilize information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality
consults with supervisor and others in overcoming barriers in meeting goals and objectives
presents cases at case conferences for multidisciplinary focus to benefit overall claim management
utilizes case management processes in compliance with regulatory and company policies and procedures
utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversations
identifies and escalates member’s needs appropriately following set guidelines and protocols
need to actively reach out to members to collaborate/guide their care
perform medical necessity reviews.

Requirements

What you’ll need

5+ years’ experience as a Registered Nurse
1+ years’ experience documenting electronically using a keyboard
1+ years’ current or previous experience in Oncology
A RN who resides in a compact state is required to have an active multistate license through the Nurse Licensure Compact (NLC)
Nurses residing in non‑compact states must hold an individual, state‑specific RN license for each state they support
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.
Bachelor's Degree Education Diploma or Associates Degree in Nursing required.

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
other resources, based on eligibility

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

telephonic case managementclinical judgmentmotivational interviewingmedical necessity reviewsUtilization ReviewOncology experienceMCGNCCNLexicompelectronic documentation

Soft Skills

collaborationcommunicationproblem-solvingpatient engagementteamworkpresentation skillsgoal-orientedadaptabilitycritical thinkingempathy

Certifications

Registered Nurse (RN)CCMURAC accreditation