Case Manager RN

Job DescriptionNurse Case Manager 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. This Case Manager RN role is 100% remote and employees can apply from any state. Normal Working Hours: Monday through Friday 8:00am-4:30pm EST. There is a rotation to cover 10:30am-7:00pm EST several times per Quarter. In addition, there is a weekend and holiday rotation per the needs of the department- 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.- Services strategies policies and programs are comprised of network management and clinical coverage policies.- 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 take into account 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 statusPay 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 QualificationsA 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 non-compact states. - 3+ years of acute care experience as an RN required.Preferred QualificationsPreferred Qualifications :- Compact State licensure preferred.- CCM certification preferred. - Microsoft Suite familiarity preferred. - Managed care case management preferred.- Home Care experience preferred. - Strong computer skills preferred.EducationAssociate's degree with RN licensure required. BSN or higher preferred.Business OverviewBring your heart to CVS Health Every 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. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Created: 2025-11-15