Case Manager - Registered Nurse

The Muse; Austin (TX); Remote; USD 60,000 - 130,000; Full time

Job summary

A leading company in health solutions seeks a Case Manager - Registered Nurse to join their remote team. The position involves case and utilization management, ensuring comprehensive care through assessment, planning, and coordination. Ideal for experienced RNs with a passion for enhancing patient well-being, the role offers competitive pay, benefits, and opportunities for professional growth.

Benefits

Medical benefits

401(k) plan

Stock purchase plan

Paid time off

Flexible schedules

Wellness programs

Qualifications

• Active compact RN licensure in state of residence is required.
• 5+ years of clinical practice as an RN with 2 years in critical care.
• 6+ months of case or utilization management experience.

Responsibilities

• Develop proactive strategies to enhance members' wellness.
• Evaluate member needs and benefit plan eligibility using clinical tools.
• Ensure compliance with regulatory and company policies in case management.

Skills

Clinical Judgment

Patient Engagement

Case Management

Data Review

Critical Thinking

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Job description

Join to apply for the Case Manager - Registered Nurse role at The Muse.

At CVS Health, we're building a world of health around every consumer with dedicated colleagues passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through 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 more connected, convenient, and compassionate. We do it all with heart, each day.

Position Summary

This Case Manager - Registered Nurse (RN) position is with Aetna's National Medical Excellence (NME) team and is fully remote. Candidates from any state are welcome to apply, with a preference for those in compact RN states. The role involves both Case Management and Utilization Management activities. The RN Case Manager assesses, plans, implements, and coordinates case management activities via telephone and face-to-face interactions to evaluate and facilitate members' overall wellness.

Responsibilities

• Develop proactive strategies to address issues and improve short and long-term outcomes, enhancing members' wellness through integration.
• Use clinical tools and data review to evaluate member needs and benefit plan eligibility, facilitating smooth transitions to Aetna programs.
• Apply clinical judgment to strategies that reduce risk factors and barriers, addressing complex health and social indicators impacting care.
• Consider information from various sources to address all health conditions, including co-morbidities and multiple diagnoses.
• Review prior claims to assess their impact on current case management and eligibility.
• Assess the member's work capacity and related restrictions or limitations.
• Holistically assess the need for referrals to clinical resources for functionality evaluation.
• Consult with supervisors and colleagues, present cases at conferences for multidisciplinary focus.
• Ensure compliance with regulatory and company policies in case management processes.
• Engage members effectively during interviews to discern health status and needs.

Qualifications

• Active, current, and unrestricted compact RN licensure in the state of residence.
• At least 5 years of clinical practice as an RN.
• Minimum of 2 years' experience in critical care.
• At least 6 months of case or utilization management experience.
• Availability to work Monday to Friday, 8 AM to 5 PM in the local time zone.
• Ability to obtain multi-state RN licensures.

Preferred Qualifications

• Case Management Certification.
• Experience with transplants.

Education

• Associate's Degree in Nursing (required).
• Bachelor's Degree in Nursing (preferred).

Additional Information

Expected weekly hours: 40. Full-time employment. Pay range: $60,522 - $129,615, depending on experience and location. Position is eligible for bonuses and incentives. Benefits include medical, 401(k), stock purchase plan, wellness programs, paid time off, flexible schedules, and more. Application deadline: 06/29/2025.

Employment Details

• Level: Mid-Senior
• Type: Full-time
• Function: Healthcare Provider