Case Manager - Registered Nurse (EST)

4062 Aetna Resources, LLC; Kentucky; On-site; USD 61,000 - 130,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a Nurse Case Manager to coordinate care for catastrophically ill and chronically ill members within the health plan network.

The role requires an active Compact RN license in the state of residence, at least two years in care management and Medicare experience, with duties spanning assessment, care planning, and collaboration with providers and payers.

Qualifications

• Must reside in an EST state.
• Active and unrestricted Compact RN licensure in state of residence.
• 2+ years of care management experience.
• 2+ years of Medicare experience.

Responsibilities

• Coordinate case management for catastrophic cases and chronically ill members across the continuum of care.
• Interact with members telephonically or in person, including homes, worksites, or physician offices as needed.
• Evaluate needs and develop care plans to optimize wellness and outcomes.
• Document case work activities and liaise with providers, employers, and insurers.
• Support education and prevention information to improve medical outcomes.

Skills

Care management

Medicare experience

RN licensure (Compact)

EST residency

Education

Associate’s Degree in Nursing

Bachelor’s Degree in Nursing (preferred)

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

• Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.
• Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care.
• Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services.
• Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate.
• Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person.
• Prepares all required documentation of case work activities as appropriate.
• Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes.
• May make outreach to treating physician or specialists concerning course of care and treatment as appropriate.
• Provides educational and prevention information for best medical outcomes.
• Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources.
• Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work.
• 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/client’s overall wellness through integration.
• Monitors member/client progress toward desired outcomes through assessment and evaluation.

Required Qualifications

• Candidate must reside in an Eastern Standard Time Zone (EST) state
• Candidate must have active and unrestricted Compact Registered Nurse (RN) licensure in state of residence
• 2+ years of experience in care management
• 2+ years of Medicare experience

Preferred Qualifications

• Geriatric experience
• E experience working in a Multicultural setting, or person multicultural experience
• Certified Case Manager
• National professional certification (CRC, CDMS, CRRN, COHN, or CCM)

Education

• Associate’s Degree in Nursing AND relevant experience in a health care-related field (REQUIRED)
• Bachelor’s Degree in Nursing (PREFERRED)

License

• Active and unrestricted Compact Registered Nurse (RN) licensure in 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 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: 09/29/2026

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