A1A Case Manager RN - Registered Nurse - NC

IntelliResume; Sands Township (MI); Hybrid; USD 54,000 - 117,000; Full time

Benefits offered by this job

Medical, Dental, Vision

Paid time off

Retirement plan

Wellness programs

Job summary

CVS Health is seeking an RN Case Manager to join the Aetna One Advocacy team. You will assess, plan, implement, and coordinate care to enhance member wellness and outcomes. This role emphasizes collaboration, regulatory compliance, and effective interviewing with diverse members to drive proactive, holistic care.

The position supports remote work with residency near High Point, NC, and requires 3+ years of RN experience, an active RN license, and possible multi-state privileges.

Qualifications

• Associates Degree in Nursing required; BSN preferred.
• 3+ years of clinical practice experience as an RN required.
• Current RN License in state of residence required; multi-state/compact privileges preferred.
• Willingness to obtain all 50 state licenses upon hire.

Responsibilities

• Develop a proactive course of action to enhance member outcomes and overall wellness.
• Conduct evaluations of member needs and benefit plan eligibility using clinical tools and data review.
• Apply clinical judgment to reduce risk factors and address complex health and social indicators.
• Assess information from various sources to address co-morbid and multiple diagnoses.
• Review prior claims to assess potential impacts on current case management.
• Assess member's work capacity and related restrictions/limitations.
• Utilize a holistic approach to determine the need for referrals to clinical resources.
• Consult with supervisors and present cases at case conferences for multidisciplinary focus.
• Utilize case management processes in compliance with regulatory and company policies.
• Engage members through effective interviewing skills to discern their health status and needs.

Skills

Clinical assessment

Care coordination

Interdisciplinary collaboration

Education

Associates Degree in Nursing

BSN preferred

Job description

About This Role

The RN Case Manager role is part of Aetna One Advocacy (A1A) and involves assessing, planning, implementing, and coordinating case management activities to enhance member wellness. This position is ideal for experienced RNs looking to work in a supportive and innovative healthcare environment.

Highlights

• Pay: $54,095 - $116,760/year
• Location: Remote, NC
• Residency: Must live within a commutable distance of High Point, NC (typically within 45 minutes maximum)
• Schedule: Full-time, Normal Working Hours: 8am-4:30pm EST

What You'll Do

• Develop a proactive course of action to enhance member outcomes and overall wellness.
• Conduct evaluations of member needs and benefit plan eligibility using clinical tools and data review.
• Apply clinical judgment to reduce risk factors and address complex health and social indicators.
• Assess information from various sources to address co-morbid and multiple diagnoses.
• Review prior claims to assess potential impacts on current case management.
• Assess member's work capacity and related restrictions/limitations.
• Utilize a holistic approach to determine the need for referrals to clinical resources.
• Consult with supervisors and present cases at case conferences for multidisciplinary focus.
• Utilize case management processes in compliance with regulatory and company policies.
• Engage members through effective interviewing skills to discern their health status and needs.

Requirements

Education:

• Associates Degree in Nursing required, BSN preferred.

Experience:

• 3+ years of clinical practice experience as an RN required.

Licenses & Certifications:

• Current RN License in state of residence required, preferably with multi-state/compact privileges.
• Willingness to obtain all 50 state licenses upon hire.

Benefits

• Medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs and other resources

About CVS Health

CVS Health is a leading healthcare provider committed to delivering exceptional patient care. They focus on innovation and quality, striving to simplify healthcare for individuals and communities.