Case Manager RN

Job DescriptionThis Case Manager RN position is for a high-risk maternity case management team and experience with this is required.Normal Working Hours: Monday through Friday 10:30am-7:00pm EST with a rotation to cover a full week of evening hours from 12:30pm-9:00pm EST every 15th week but the frequency and hours may change per the need of the department. There are no weekend hours.There are no holiday coverage hours.There is no travel. This is a 100% remote work from home position and candidates from any state can apply. There is a preference for an RN with Compact RN Licensure, however, it is not required. The Case Manager RN 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 to facilitate the member's overall wellness within a high-risk maternity case management program. The Case Manager RN is empowered to take care of all aspects of a member's maternity journey. The Case Manager RN develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member's overall wellness through integration. The Case Manager RN includes some of the following roles (not all inclusive): -Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans. -Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues. -Assessments consider information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. -Reviews prior claims to address potential impact on current case management and eligibility. -Assessments include the member's level of work capacity and related restrictions/limitations. -Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality. -Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. -Utilizes case management processes in compliance with regulatory and company policies and procedures. -Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.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-Must hold an active and unrestricted RN License.-Applicants must be willing and able to pursue multi-state licensure (paid for by the company).-Minimum of 3+ years of clinical experience as an RN in an inpatient or outpatient setting focused on women's health, maternity and/or OB-GYN office setting.COVID 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 RN Licensure-BSN-1+ years of Case Management experience in an integrated model-1+ years of experience with Telephonic Case Management-Experience with all types of Microsoft Office including PowerPoint, Excel, and Word-Certified Case Manager (CCM) certification-Experience with ATV/ASDEducationAssociates Degree NursingBusiness 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