Case Manager RN

Job DescriptionThis position will be a full-time telework anywhere in the United States. Schedule: Monday- Friday 8:00am - 5:00pm.No weekends, holidays or travel will be required. Utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. - Monitor clinical care services provided to members related to mental health and substance abuse treatment to optimize clinical outcomes. - Provide telephone triage and crisis intervention. - Provide information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and Aetna Behavioral Health policies and procedures, and criteria. - Interact with Physician Advisors to discuss clinical questions and concerns regarding specific cases. - Participate in QI activities including data collection, tracking, and analysis. Telephonic clinical case management with Medicare population. - Uses Motivational Interviewing and engagement interventions to optimize member participation in case management programs. - Completes a Comprehensive Assessment and Plan of care. - Will document in clinical systems to support legacy Aetna and Coventry membership.- Provides BH consultation and collaboration with Aetna partners. - Active participation in clinical treatment rounds. - Active participation in team activities focused on program development. Innovative thinking expected.Pay RangeThe typical pay range for this role is:Minimum: 55,300Maximum: 118,900Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications- 3+ years of clinical experience required - RN (current and unrestricted license)- 1+ year of behavioral health or DSNP experience requiredCOVID 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- 2+ years of managed care experience highly preferred- 2+ years of case management experience- Discharge planning experience- Utilization review, prior authorization, concurrent review, appeals experience- Advanced crisis intervention skills- CCM preferredEducationRN licensure (current and unrestricted license).Associates or bachelors degree in nursing requiredBusiness 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