Case Manager, Registered Nurse (Remote)

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

Job summary

An established industry player is seeking a dedicated Nurse Care Manager to join their telework team. This role involves assessing and coordinating care for members, utilizing clinical judgment to enhance wellness and address complex health needs. With a focus on compassionate care, you will develop proactive plans and engage with interdisciplinary teams to improve health outcomes. This position offers a unique opportunity to make a significant impact on the lives of dual eligible populations while enjoying the flexibility of a full-time telework role. Join a company that values its colleagues and offers comprehensive benefits to support your well-being.

Benefits

Affordable medical plan options

401(k) plan with matching contributions

Employee stock purchase plan

Wellness screenings

Tobacco cessation programs

Weight management programs

Confidential counseling

Financial coaching

Paid time off

Flexible work schedules

Qualifications

• Must have active RN licensure in South Carolina or compact licensure.
• 3+ years of clinical experience required.

Responsibilities

• Assess and coordinate case management activities with members.
• Develop proactive care plans to enhance member wellness.

Skills

Clinical Experience

Case Management

Analytical Skills

Problem-Solving Skills

Communication Skills

Interpersonal Skills

Education

Associate's Degree in Nursing

Bachelor’s Degree

Tools

MS Word

Excel

Outlook

PowerPoint

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.

This is a full-time telework role.

The hours for this position are Monday-Friday 8 AM - 5 PM EST.

Position Summary/Mission

Aetna is as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. We collaborate with members, providers, and community organizations in pursuit of quality solutions that address the full continuum of our members’ health care and social determinant needs. Dual Eligible Special Needs Plans (DSNP) members are enrolled in Medicare and Medicaid. Our Care Managers are frontline advocates for members who cannot advocate for themselves. Join us in this exciting opportunity as we grow and expand DSNP into new markets across the country.

• Nurse Care Manager is responsible for 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.
• Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness.
• Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits.
• Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning.
• Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality.
• Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members.
• Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences.
• Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Required Qualifications

• Must have active and unrestricted Registered Nurse (RN) licensure in the state of South Carolina OR compact licensure in state of residence
• 3+ years of clinical experience
• 2+ years of case management, discharge planning and/or home healthcare coordination experience

Preferred Qualifications

• Certified Case Manager
• Excellent analytical and problem-solving skills
• Effective communications, organizational, and interpersonal skills
• Ability to work independently
• Effective computer skills including navigating multiple systems and keyboarding
• Proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications

Education

• Associate's Degree in Nursing (REQUIRED) with equivalent experience
• Bachelor’s Degree (PREFERRED)

Certification

• Must have active and unrestricted Registered Nurse (RN) licensure in the state of South Carolina OR compact licensure in state of residence

Anticipated Weekly Hours

40

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.

This is a full-time telework role.

The hours for this position are Monday-Friday 8 AM - 5 PM EST.

Position Summary/Mission

Aetna is as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. We collaborate with members, providers, and community organizations in pursuit of quality solutions that address the full continuum of our members’ health care and social determinant needs. Dual Eligible Special Needs Plans (DSNP) members are enrolled in Medicare and Medicaid. Our Care Managers are frontline advocates for members who cannot advocate for themselves. Join us in this exciting opportunity as we grow and expand DSNP into new markets across the country.

Fundamental Components

• Nurse Care Manager is responsible for 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.
• Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness.
• Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits.
• Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning.
• Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality.
• Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members.
• Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences.
• Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Required Qualifications

• Must have active and unrestricted Registered Nurse (RN) licensure in the state of South Carolina OR compact licensure in state of residence
• 3+ years of clinical experience
• 2+ years of case management, discharge planning and/or home healthcare coordination experience

Preferred Qualifications

• Certified Case Manager
• Excellent analytical and problem-solving skills
• Bilingual
• Effective communications, organizational, and interpersonal skills
• Ability to work independently
• Effective computer skills including navigating multiple systems and keyboarding
• Proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications

Education

• Associate's Degree in Nursing (REQUIRED) with equivalent experience
• Bachelor’s Degree (PREFERRED)

Certification

• Must have active and unrestricted Registered Nurse (RN) licensure in the state of South Carolina OR compact licensure in state of residence

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 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: 05/21/2025

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

About the company

At CVS Health, we share a clear purpose: helping people on their path to better health. Through our health services, plans and community pharmacists, we’re pioneering a bold new approach to total health. Making quality care more affordable, accessible, simple and seamless, to not only help people get well, but help them stay well in body, mind and spirit.