Case Manager RN

Job DescriptionThe Hours for the role are Monday - Friday 8am-4:30pm,with a 10:30am-7pm rotation 1-2x quarterly. No weekends or holidays will be required. Travel to the office may be required. Candidates are preferred to live in OH. Nurse Case Manager is responsible for telephonicallyand/or face to face assessing, planning, implementing andcoordinating all case management activities with membersto evaluate the medical needs of the member tofacilitate the member's overall wellness.- Develops a proactive course of action to address issuespresented to enhancethe short and long-term outcomes as well as opportunitiesto enhance amember's overall wellness through integration.- Services strategies policies and programs are comprisedof networkmanagement and clinical coverage policies.- Through the use of clinical tools and information/datareview, conducts anevaluation of member's needs and benefit plan eligibilityand facilitatesintegrative functions as well as smooth transition to Aetnaprograms and plans.- Applies clinical judgment to the incorporation of strategiesdesigned to reducerisk factors and barriers and address complex health andsocial indicators whichimpact care planning and resolution of member issues- Assessments take into account information from varioussources to address allconditions including co-morbid and multiple diagnoses thatimpact functionality.- Reviews prior claims to address potential impact oncurrent case managementand eligibility.- Assessments include the member's level of work capacityand relatedrestrictions/limitations.- Using a holistic approach assess the need for a referralto clinical resourcesfor assistance in determining functionality.- Consults with supervisor and others in overcomingbarriers in meeting goalsand objectives, presents cases at case conferences formultidisciplinary focusto benefit overall claim management.- Utilizes case management processes in compliance withregulatory andcompany policies and procedures.- Utilizes interviewing skills to ensure maximum memberengagement and discern their health statusRequired Qualifications-A Registered Nurse that must hold an unrestricted licensein their state of residence, with multi-state/compactprivileges and have the ability to be licensed in all noncompact 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 SkillsEducationAssociates 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: 2025-10-04