Case Manager RN

Job DescriptionThis is a full-time telework role open to candidates who live in Kansas.Candidate must reside in Kansas (Central, Topeka, Northeast, Eastern KS) The role will require 50-75% travel in assigned regions.Schedule is Monday-Friday, standard business hours.The dedication of talented and caring health care professionals drives thedelivery of high quality, cost effective products and services. They make itpossible for members to get the right health care treatment for their needs- and for Aetna to keep its competitive edge.Facilitate the delivery of appropriate benefits and/or healthcare informationwhich determines eligibility for benefits while promoting wellness activities.Develops, implements and supports Health Strategies, tactics, policies andprograms that ensure the delivery of benefits and to establish overallmember wellness and successful and timely return to work. Services andstrategies, policies and programs are comprised of network management,clinical coverage, and policies.Nurse Case Manager is responsible for telephonically and/or face to faceassessing, planning, implementing and coordinating all case managementactivities with members to evaluate the medical needs of the member tofacilitate the member's overall wellness. Develops a proactive course ofaction to address issues presented to enhance the short and long-termoutcomes as well as opportunities to enhance a member's overall wellnessthrough integration. Services strategies policies and programs arecomprised of network management and clinical coverage policies.Through the use of clinical tools and information/data review, conducts anevaluation of member's needs and benefit plan eligibility and facilitatesintegrative functions as well as smooth transition to Aetna programs andplans. Applies clinical judgment to the incorporation of strategies designedto reduce risk factors and barriers and address complex health and socialindicators which impact care planning and resolution of member issues.Assessments take into account information from various sources to addressall conditions including co-morbid and multiple diagnoses that impactfunctionality. Reviews prior claims to address potential impact on currentcase management and eligibility. Assessments include the member's level ofwork capacity and related restrictions/limitations. Using a holistic approachassess the need for a referral to clinical resources for assistance indetermining functionality. Consults with supervisor and others inovercoming barriers in meeting goals and objectives, presents cases atcase conferences for multidisciplinary focus to benefit overall claimmanagement. Utilizes case management processes in compliance withregulatory and company policies and procedures. Utilizes interviewing skillsto ensure maximum member engagement and discern their health statusand health needs based on key questions and conversation.Required Qualifications-Registered Nurse with current unrestricted licensure in Kansas.-3+ years clinical practice experienceCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationsCase Management in an integrated model preferredBilingual preferredExperience with chronic conditions or behavioral healthEducationRN with current unrestricted state licensure required.Business OverviewAt Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Created: 2025-10-04