Case Manager RN

Job DescriptionNurse Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member tofacilitate the member's overall wellness. The Hours for the role are Monday - Friday 8am-4:30pm, with a10:30am-7pm rotation 1-2x quarterly- Develops a proactive course of action to address issues presented to enhancethe short and long-term outcomes as well as opportunities to enhance amember's overall wellness through integration.- Services strategies policies and programs are comprised of networkmanagement 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 and plans.- Applies clinical judgment to the incorporation of strategies designed to reducerisk factors and barriers and address complex health and social indicators whichimpact care planning and resolution of member issues- Assessments take into account information from various sources to address allconditions including co-morbid and multiple diagnoses that impact functionality.- Reviews prior claims to address potential impact on current case managementand eligibility.- Assessments include the member's level of work capacity and relatedrestrictions/limitations.- Using a holistic approach assess the need for a referral to clinical resourcesfor assistance in determining functionality.- Consults with supervisor and others in overcoming barriers in meeting goalsand objectives, presents cases at case conferences for multidisciplinary focusto benefit overall claim management. - Utilizes case management processes in compliance with regulatory andcompany policies and procedures.- Utilizes interviewing skills to ensure maximum member engagement and discern their health status aRequired Qualifications-A Registered Nurse that must hold an unrestricted license in their state of residence, with multi-state/compact privileges and have the ability to be licensed in all non-compact states. - 3 years minimum of acute care 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 Qualifications-Compact State licensure- CCM certification- Microsoft Suite familiar- Managed care case management- Home Care Experience-Strong Computer SkillsEducationAssociate's or higher RN license in state of residenceBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-11-15