A1A Case Manager RN - Registered Nurse - OH

IntelliResume; Kentucky; Hybrid; USD 61,000 - 130,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an RN Case Manager for the Aetna One Advocacy program. The role involves assessing, planning, implementing, and coordinating case management to support member wellness. The position targets experienced nurses who enjoy delivering high-quality care and guidance.

With a Remote, OH location, this full-time role operates 8am-4:30pm EST, occasionally later shifts. Candidates should have a nursing license, 3+ years of experience, and the willingness to obtain additional state

Qualifications

• Associates Degree in Nursing is required.
• BSN preferred.
• 3+ years of clinical RN practice.
• Unrestricted RN license in state of residence; multi-state/compact privileges preferred.

Responsibilities

• Develop proactive plans to improve member outcomes and overall wellness.
• Evaluate member needs and benefit eligibility using clinical tools and data review.
• Apply clinical judgment to reduce risk factors and address complex health and social indicators.
• Assess members' conditions, including co-morbidities and multiple diagnoses affecting function.
• Review prior claims to evaluate impact on case management and eligibility.
• Assess work capacity and related restrictions/limitations.
• Refer to clinical resources as needed through a holistic approach.
• Consult with supervisors and present cases at conferences for multidisciplinary focus.
• Follow case management processes in line with regulatory and company policies.
• Engage members through interviews to determine health status and needs.

Education

Associates Degree in Nursing

BSN

Job description

About This Role

The RN Case Manager role at CVS Health 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 nurses who are passionate about providing high-quality care and support to members.

Highlights

• Pay: $60,522 - $129,615/year
• Location: Remote, OH
• Residency: Must live within a commutable distance of New Albany, Ohio (typically within 45 minutes maximum)
• Schedule: Full-time, 8am-4:30pm EST with occasional later shifts

What You'll Do

• Develop proactive courses 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 members' conditions, including co-morbidities and multiple diagnoses impacting functionality.
• Review prior claims to evaluate their impact on current case management and eligibility.
• Assess members' work capacity and related restrictions/limitations.
• Use a holistic approach to determine the need for referrals to clinical resources.
• Consult with supervisors and present cases at conferences for multidisciplinary focus.
• Utilize case management processes in compliance with regulatory and company policies.
• Engage members through effective interviewing 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:

• Unrestricted 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 accountability, striving to simplify healthcare for individuals and communities.