Case Manager Registered Nurse - RNN- Maternity

CVS Health; United States; Remote; USD 54,000 - 143,000; Full time

Job summary

Join CVS Health as a Case Manager Registered Nurse in a 100% remote position focusing on high-risk maternity cases. This role requires telephonic and face-to-face assessments to coordinate and ensure the best care for members, enhancing their overall wellness in a supportive environment. Candidates must have a compact RN license and relevant experience in OB-GYN or women's health to be considered.

Benefits

Affordable medical plan options

401(k) plan with company contributions

Employee stock purchase plan

Wellness screenings and counseling programs

Paid time off and flexible work schedules

Qualifications

• Active and unrestricted RN License required.
• Minimum of 3+ years clinical experience in women's health, maternity, or OB-GYN.
• Preferred RN licensure in a compact state.

Responsibilities

• Assessing and coordinating case management activities to facilitate member's wellness.
• Conducting evaluations of member needs and facilitating transitions to Aetna programs.
• Applying clinical judgment to address complex health and social indicators.

Skills

Clinical judgment

Assessments

Case Management

Holistic approach

Education

Associates Degree in Nursing

BSN Preferred

Tools

Microsoft Office

Job description

Case Manager Registered Nurse - RNN- Maternity

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

Normal Working Hours: Monday-Friday 8:00am - 4:30 pm in your local time zone

There are no weekend hours.

There are no holiday coverage hours.

There is no travel.

This is a 100% remote work from home position and candidates from any state with a compact RN license can apply.

This position is for a high-risk maternity case management team and experience with this is required.

The Case Manager RN 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 within a high-risk maternity case management program. The Case Manager RN is empowered to take care of all aspects of a member's maternity journey.

The Case Manager RN 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.

The Case Manager RN includes some of the following roles (not all inclusive):

-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:

-Must hold an active and unrestricted RN License.

-Applicants must be willing and able to pursue multi-state licensure (paid for by the company).
-Minimum of 3+ years of clinical experience as an RN in an inpatient or outpatient setting focused on women's health, Infertility, maternity and/or OB-GYN office setting.

Preferred Qualifications:

-BSN

-Preferred RN licensure in a compact state

-1+ years of Case Management experience in an integrated model

-1+ years of experience with Telephonic Case Management

-Experience with all types of Microsoft Office including PowerPoint, Excel, and Word

-Experience with ATV/ASD

Education

Associates Degree Nursing, BSN Preferred

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.

Position Summary

Normal Working Hours: Monday-Friday 8:00am - 4:30 pm in your local time zone

There are no weekend hours.

There are no holiday coverage hours.

There is no travel.

This is a 100% remote work from home position and candidates from any state with a compact RN license can apply.

This position is for a high-risk maternity case management team and experience with this is required.

The Case Manager RN 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 within a high-risk maternity case management program. The Case Manager RN is empowered to take care of all aspects of a member's maternity journey.

The Case Manager RN 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.

The Case Manager RN includes some of the following roles (not all inclusive):

-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:

-Must hold an active and unrestricted RN License.

-Applicants must be willing and able to pursue multi-state licensure (paid for by the company).
-Minimum of 3+ years of clinical experience as an RN in an inpatient or outpatient setting focused on women's health, Infertility, maternity and/or OB-GYN office setting.

Preferred Qualifications:

-BSN

-Preferred RN licensure in a compact state

-1+ years of Case Management experience in an integrated model

-1+ years of experience with Telephonic Case Management

-Experience with all types of Microsoft Office including PowerPoint, Excel, and Word

-Certified Case Manager (CCM) certification

-Experience with ATV/ASD

Education

Associates Degree Nursing, BSN Preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,095.00 - $142,576.00

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: 06/06/2025

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.

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