Case Manager - Registered Nurse

Austin Bar Assocation; Austin (TX); Remote; USD 60,000 - 130,000; Full time

Job summary

A leading health solutions company is looking for a Case Manager - Registered Nurse (RN) to coordinate case management activities and assess members' medical needs. This fully remote position requires significant nursing experience and licensure, contributing to improved member health outcomes through comprehensive care management.

Benefits

401(k) plan with company matching

Affordable medical plan options

Flexible work schedules

Qualifications

• Must have an active, current, and unrestricted compact Registered Nurse (RN) licensure.
• 5 years clinical practice experience as an RN.
• 2+ years experience in critical care.

Responsibilities

• Conduct assessments to improve wellness outcomes.
• Facilitate case management activities using clinical tools.
• Utilize interviewing skills for member engagement.

Skills

Critical thinking

Communication

Patient assessment

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Job description

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

This Case Manager - Registered Nurse (RN) position is with Aetna's National Medical Excellence (NME) team and is a fully remote position. Candidates from any state are welcome to apply, however, preference is for candidates in compact Registered Nurse (RN) states.

This role is a blended role doing both Case Management and Utilization Management. 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.

Case Manager - Registered Nurse

• 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-morbid 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

• Candidate must have an active, current and unrestricted compact Registered Nurse (RN) licensure in the state of residence
• 5 years clinical practice experience as an Registered Nurse (RN)
• 2+ years' experience in critical care
• 6+ months case management or utilization management experience
• Must be able to work Monday - Friday 8 AM to 5 PM in the time zone of residence (There are currently no nights, weekends, and holidays; however, is subject to change based on business needs)
• Must be able to obtain multi state Registered Nurse (RN) licensures

Preferred Qualifications

• Case Management Certification
• Transplant experience

Education

• Associate's Degree in Nursing (REQUIRED)
• Bachelor's Degree in Nursing (PREFERRED)

License

• Must have an active, current and unrestricted compact Registered Nurse (RN) licensure in the state of residence

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 - 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 https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 06/29/2025

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