Case Manager Registered Nurse (Field - Must reside in Northern Virginia)

CVS Health; United States; Remote; Full time

Job summary

A leading health solutions company seeks a Nurse Case Manager responsible for assessing and coordinating care for members. This role involves evaluating medical needs, implementing strategies for wellness, and ensuring compliance with policies. The ideal candidate will have RN licensure and clinical experience, with a focus on improving health outcomes through integrated services.

Benefits

Comprehensive medical plans

401(k)

Employee stock purchase plan

Wellness programs

Paid time off

Flexible schedules

Family leave

Qualifications

• RN with current unrestricted Virginia state licensure.
• At least 3 years of clinical experience as a Registered Nurse.

Responsibilities

• Assessing, planning, implementing, and coordinating case management activities.
• Evaluating members' needs and facilitating transitions to Aetna programs.

Skills

Bilingual in English/Spanish

Effective verbal and written communication skills

Ability to multitask

Proficiency with computer systems

Education

Associate degree

Bachelor’s degree

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

The Nurse Case Manager is responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate their medical needs and facilitate overall wellness. They develop proactive strategies to address issues, aiming to improve short- and long-term health outcomes and enhance members' wellness through integrated services, policies, and programs, including network management and clinical coverage policies.

Using clinical tools and data review, the Nurse Case Manager evaluates members' needs and benefit plan eligibility, facilitating smooth transitions to Aetna programs and plans. They apply clinical judgment to strategies that reduce risk factors and barriers, addressing complex health and social indicators impacting care planning and resolution of member issues. Assessments consider multiple conditions, including co-morbidities, and review prior claims to understand their impact on current case management and eligibility. They assess members' work capacity, restrictions, and limitations, and may refer to clinical resources for further assistance. The role involves consulting with supervisors, presenting cases for multidisciplinary focus, and ensuring compliance with regulatory and company policies. The Nurse Case Manager utilizes interviewing skills to maximize member engagement and accurately discern health status and needs.

Required Qualifications

• RN with current unrestricted Virginia state licensure
• At least 3 years of clinical experience as a Registered Nurse (e.g., med-surg, behavioral health, acute care)
• Reliable transportation and willingness to travel up to 75% to meet members in their homes, with mileage reimbursed
• Reside in Fairfax County or surrounding areas, including Fairfax, Alexandria, Arlington, Annandale, McLean, Vienna, Falls Church, Springfield

Preferred Qualifications

• Experience in Case Management within an integrated model
• Bilingual in English/Spanish
• Ability to multitask, prioritize, and adapt in a fast-paced environment
• Proficiency with computer systems and keyboarding skills
• Effective verbal and written communication skills

Education

• Associate degree required
• Bachelor’s degree preferred
• Current unrestricted Virginia LPN/RN licensure required

Additional Details

Anticipated weekly hours: 40

Position type: Full time

Pay range: $22.40 - $48.67 per hour, depending on experience and other factors

Benefits and Company Culture

We offer comprehensive benefits including medical plans, 401(k), employee stock purchase plan, wellness programs, paid time off, flexible schedules, family leave, and more. For details, visit our benefits page.

Application deadline: 05/19/2025

CVS Health is committed to diversity, equity, and inclusion, and complies with all relevant laws regarding employment and vaccination requirements. We provide accommodations for disabilities and medical conditions. For accommodation requests, contact [e-mail] or call 7-1-1 for TRS services.