Case Manager RN

Job DescriptionThe Care Manager utilizes a collaborative process ofassessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes.The CM process includes: assessing the member's healthstatus and care coordination needs, inpatient review anddischarge planning, developing and implementing the CMplan, monitoring and evaluating the plan and involving theMedical Director as indicated and closing the case asappropriate when the member has met discharge criteria.The responsibilities of this position are to apply data driven methods of identification of members to fashionindividualized case management programs and/or referrals to alternative healthcare programs. tConducts comprehensive clinical assessments. Evaluates needs and develops flexible approaches based on member needs, benefit plans or external programs/services.tAdvocates for patients to the full extent of existing health care coverage.tPromotes quality, cost effective outcomes and makes suggestions to improve program/operational efficiency.tIdentifies and escalates quality of care issues through established channels. Expectation is a very high level of customer service.tProvides coaching, information, education and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.tFundamental components related to the Aetna One Premier program include but are not limited to; Utilizes assessment techniques to determine member's level of health literacy, technology capabilities, and/or readiness to change.tAbility to exercise independent and sound judgment, has strong decision-making skills and well-developed interpersonal skills.tAbility to manage multiple priorities, effective organizational and time management skills along with strong teamwork skills.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 QualificationsRegistered Nurse with active and unrestricted licensure in state of residenceMinimum 3+ years clinical experience1-3+ years of Managed Care experiencePrior experience within a telephonic customer servicecenter type of environment preferredFamiliarity with influencing/motivational interviewing skills to ensure maximum member engagement and promotelifestyle/behavior changes to achieve optimum level ofhealthCOVID 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 QualificationsCCMCompact State LicensureEducationRegistered Nurse: Associate; Diploma; or Bachelor degreeBusiness 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: 2025-11-01