Case Manager

CVS Health; United States; Remote; USD 54,000 - 117,000; Full time

Benefits offered by this job

Comprehensive benefits

Paid time off

Retirement savings options

Job summary

CVS Health is seeking a registered nurse to perform case management, coordinating care for members via telephonic and face-to-face encounters. The RN will assess medical needs, plan interventions, and coordinate with appropriate programs to improve overall wellness.

This is a full-time role with a focus on patient-centered care and collaboration with multidisciplinary teams. The position requires an active RN license, 3+ years of clinical practice, and strong communication and bilingual

Qualifications

• RN licensure in the state of residence (multi-state/compact preferred).
• Minimum 3 years of clinical practice experience.
• Bachelor’s degree preferred; associate’s degree required.
• Bilingual English/Spanish is a plus.

Responsibilities

• 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 clinical tools and information/data review, evaluates member needs and benefit plan eligibility and facilitates integration with Aetna programs.
• Applies clinical judgment to strategies designed to reduce risk factors and address barriers affecting care planning.
• Assessments consider information from various sources to address all conditions including co-morbidity and multiple diagnoses that impact functionality.
• Reviews prior claims to address potential impact on current case management and eligibility.
• Assessments include the member's work capacity and related restrictions/limitations.
• Refer to clinical resources for assistance in determining functionality; consults with supervisor to overcome barriers.

Skills

Bilingual (English/Spanish)

Case management experience

Strong communication skills

Education

Associate’s degree

Bachelor’s degree preferred

Tools

Microsoft Office

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.

Normal Working Hours

Monday through Friday 8:00am through 5:00pm in time zone of residence. Rotation for 8pm EST.

The RN 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.

Responsibilities

• 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.
• 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 consider information from various sources to address all conditions including co-morbidity 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 status and health needs based on key questions and conversation.

Required Qualifications

• Registered Nurse with active and unrestricted RN licensure in their state of residence, preferably with multi-state/compact privileges. Must have the ability to be licensed in all non-compact states
• 3+ years clinical practice experience required

Preferred Qualifications

• Compact RN licensure
• Case management experience
• Case Manager Certification
• Experience with using Windows / Microsoft Office
• Strong computer skills
• Bilingual(English/Spanish) speaking

Education

• Associate’s degree required, Bachelor’s degree preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,095.00 - $116,760.00

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

This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and 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: 10/26/2026

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