Case Manager Registered Nurse u2013 Field u2013 Must ...

Weu2019re building a world of health around every individual u2014 shaping a more connected, convenient and compassionate health experience. At CVS Healthu00ae, youu2019ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger u2013 helping to simplify health care one person, one family and one community at a time. Position Summary AssessmentofMembers:Throughtheuseofclinicaltoolsand information/datareview,conductscomprehensiveassessmentsofreferred memberu2019sneeds/eligibilityanddeterminesapproachtocaseresolution and/ormeetingneedsbyevaluatingmemberu2019sbenefitplanandavailable internalandexternalprograms/services.-Appliesclinicaljudgmenttothe incorporationofstrategiesdesignedtoreduceriskfactorsandaddress complexclinicalindicatorswhichimpactcareplanningandresolutionof memberissues. -Usingadvancedclinicalskills,performscrisisintervention withmembersexperiencingabehavioralhealthormedicalcrisisandrefers themtotheappropriateclinicalprovidersforthoroughassessmentand treatment,asclinicallyindicated.Providescrisisfollowuptomembersto helpensuretheyarereceivingtheappropriatetreatment/services. EnhancementofMedicalAppropriatenessandQualityofCare: -Application and/orinterpretationofapplicablecriteriaandclinicalguidelines, standardizedcasemanagementplans,policies,procedures,andregulatory standardswhileassessingbenefitsand/ormemberu2019sneedstoensure appropriateadministrationofbenefits-Usingholisticapproachconsults withsupervisors,MedicalDirectorsand/orotherprogramstoovercome barrierstomeetinggoalsandobjectivesu037epresentscasesatcase conferencestoobtainmultidisciplinaryviewinordertoachieveoptimal outcomes-Identifiesandescalatesqualityofcareissuesthrough establishedchannels-Abilitytospeaktomedicalandbehavioralhealth professionalstoinfluenceappropriatemembercare. u2013Utilizes influencing/motivationalinterviewingskillstoensuremaximummember engagementandpromoteslifestyle/behaviorchangestoachieveoptimum levelofhealth-Providescoaching,informationandsupporttoempowerthe membertomakeongoingindependentmedicaland/orhealthylifestyle choices.-Helpsmemberactivelyandknowledgablyparticipatewiththeir providerinhealthcaredecision-making-Analyzesallutilization,self-report andclinicaldataavailabletoconsolidateinformationandbegintoidentify comprehensivememberneeds.Monitoring,EvaluationandDocumentation ofCare:-Incollaborationwiththememberandtheircareteamdevelops andmonitorsestablishedplansofcaretomeetthememberu2019sgoals-Utilizes casemanagementandqualitymanagementprocessesincompliancewith regulatoryandaccreditationguidelinesandcompanypoliciesand procedures. Is responsible for face to face and/or telephonically assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the memberu2019s overall wellness. Nurse Case Manager is responsible for assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the memberu2019s overall wellness. 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 memberu2019s 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 memberu2019s 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. Required Qualifications + Must reside near North Richmond or Chesterfield Virginia area + Must possess reliable transportation and be willing and able to travel up to 50-75% of the time. Mileage is reimbursed per our company expense reimbursement policy. + RN/BH with current unrestricted Virginia state licensure required. + 3 years clinical experience (med surg, behavioral health) + Virginia Driver's License + Managed Care experience. Preferred Qualifications + Case Management in an integrated model preferred. + Bilingual preferred. Education + Associates Degree in Nursing Required. + Bachelor's of Science and Nursing Preferred. Licensure : + Registered Nurse License in State of VA in good standing + Independent Behavioral Health License in the state of VA in good standing Technology Skills: + Proficient in Multisystem Navigation: Comfortable using multiple monitors and systems simultaneously to streamline tasks and improve efficiency. + Effective Multitasker: Skilled at talking and typing concurrently while managing various responsibilities with focus and accuracy. + Basic Technical Troubleshooting: Able to set up and connect essential hardware (monitors, keyboards, etc.) and resolve common technical issues independently. + Digital Collaboration & Documentation: Experienced in electronic documentation and virtual collaboration tools to support remote teamwork and communication. + Highly Organized & Results-Oriented: Maintains a structured approach to work, ensuring tasks are completed on time and in alignment with performance metrics. + Metric-Driven Performance: Demonstrates accountability by consistently meeting or exceeding established goals and expectations. + Clean & Efficient Workspace Management: Keeps workspaces tidy and organized to support productivity and comply with professional standards. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $60,522.00 - $129,615.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits u2013 investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: + Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . + No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit We anticipate the application window for this opening will close on: 04/24/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran u2014 committed to diversity in the workplace.

Created: 2026-03-26