A1A Precertification Nurse

4062 Aetna Resources, LLC; North Carolina; Hybrid; USD 54,000 - 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 hiring a Precertification Nurse Case Manager to review medical records and determine medical necessity for elective procedures. You will communicate determinations to providers and members and guide members through the health care system with our care management team.

The role requires an active RN license, 3+ years of clinical practice, and the ability to work 8:00 AM–4:30 PM in your local time zone with occasional evening rotation.

Qualifications

• Active, current RN state licensure.
• Must reside within 45 miles to New Albany, OH; Chandler, AZ; or High Point, NC.
• 3+ years of clinical practice experience.
• Ability to work 8:00 AM–4:30 PM local time with occasional evening rotation ~2x/month.
• Position is work from home with possible on-site requirements.
• 2+ years of experience using Microsoft Office Suite.

Responsibilities

• Review medical records to determine medical necessity for elective procedures.
• Communicate current status and determinations to providers and members.
• Coordinate care with the care management team via phone.
• Assess member conditions and plan, implement, and coordinate activities.

Skills

Organizational skills

Multitasking

Communication

Education

Associates degree

BSN preferred

Tools

Microsoft Office Suite

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll 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 – helping to simplify health care one person, one family and one community at a time.

Position Summary

Must reside within 45 miles to office locations in New Albany, OH, Chandler, AZ or High Point, NC. Precertification Nurse Case Manager is responsible for reviewing medical records to determine the medical necessity for elective procedures. They are responsible for communicating the current status and determinations to our providers and members, as well as guide the members, through the health care system. They assess the members conditions and coordinate care with our care management team, telephonically assessing, planning, implementing and coordinating activities with members to evaluate the medical needs of the member, to facilitate the member’s overall wellness. Services strategies, policies and programs are comprised of network management and clinical coverage policies. This is an exciting time to join Aetna a CVS Health company in our journey to change the way healthcare is delivered today.

Fundamentals

What is A1A? Aetna One Advocate is Aetna’s premier service and clinical offering for Aetna nation-wide and creates industry-leading solutions for our customers and members. The model is a fully integrated population health and customer service solution for large plan sponsors high-touch, high-tech member advocacy service which combines data-driven processes with the expertise of highly trained clinical and concierge member services. Our mission is to meet each member at every aspect of their health care journey. Our embedded customer-dedicated service and clinical pods allow maximization of inbound and outbound touchpoints to solve members’ needs and create behavior change. Our data analytics, white-glove service and end-to-end ownership of member support creates a trusted partner in health. We are health care innovators.

Required Qualifications

• Must have active, current and unrestricted compact RN state licensure
• Must reside within 45 miles to office locations in New Albany OH, Chandler AZ or High Point NC
• 3+ years of clinical practice experience required
• Must be able to work Monday through Friday 8:00 AM to 4:30 PM, in your local time zone with evening rotation required about 2 times a month until 8pm, EST.
• This position is work from home, however may include on site work requirements from time to time including; team meetings, colleague trainings, customer visits, performance related issues, and other business needs.
• 2+ years of experience using Microsoft Office Suite applications (Teams, Outlook, Word, Excel, etc.)

Preferred Qualifications

• Ability to organize, multitask, prioritize and work in a fast pace environment.
• Computer skills

Education

Associates degree required BSN preferred

Anticipated Weekly Hours

40

Time Type Full time Pay Range

The typical pay range for this role is: $26.01 - $62.32

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.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

• medical coverage
• dental coverage
• vision coverage
• paid time off
• retirement savings options
• wellness programs
• other resources, based on eligibility

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 10/19/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Our Work Experience

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people.

Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.