Case Manager RN

Job DescriptionThis is a full-time telework role open to candidates with a MI RN licensure.Working schedule: Monday-Friday, 8am-5pm EST.RN Case Manager is responsible for the telephonic and/or in person assessing, planning, implementing and coordinating of all case management activities. Case Managers work with members and their care givers to evaluate the medical needs of the member to facilitate the member's overall wellness. The RN Case Manager role is 100% remote and travel of less than 10% may be required in the event of clinical needs and/or audits. RN Case Manager: 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. Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefits plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plan Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers, as well as address complex health and social indicators which impact care planning and resolution of member issues Uses a holistic approach to assess and analyze information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Acts as a liaison with member, family, provider, community organizations and healthcare personnel as appropriate Utilizes case management processes in compliance with regulatory and company policies and procedures Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status, health and social determinants of health needs based on key questions and conversation Reviews prior claims to address potential impact on current case management and eligibility Consults with clinical leader and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall clam managementPay 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- Active and unrestricted RN licensure in the state of MI- 3+ years of direct clinical practice experience e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility- 1+ year(s) of case/care management experiencePreferred Qualifications- Experience working with children with special needs, NICU experience, or maternity experience - Crisis intervention skills- Managed care/utilization review experience- Discharge planning experience- Experience with electronic medical records/electronic documentation- Strong written and oral communication skills - Experience with Microsoft Word and ExcelEducation- Associate's degree required- BSN preferredBusiness 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