Case Manager RN - job 1 of 2
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
This position will be working remotely. Standard business hours are Monday-Friday, with some flexibility required to accommodate members needs.
Nurse Case Manager is responsible for telephonically 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 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.
- Services strategies policies and programs are comprised of network management and clinical coverage policies.
- 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 take into account 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 to benefit overall medical 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
- 3+ years clinical practice experience required
- RN with current unrestricted compact state licensure required
- Willingness to obtain additional state licensure as needed
Preferred Qualifications
- Bilingual English/Spanish
- Med/Surg experience
- Managed care experience
- Case management experience
Education
- Associates degree required
- BSN preferred
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$54,095.00 - $116,760.00This 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: 05/30/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Average salary estimate
If an employer mentions a salary or salary range on their job, we display it as an "Employer Estimate". If a job has no salary data, Rise displays an estimate if available.
At CVS Health, we believe that health is a journey that deserves compassion and support every step of the way, and that's where you come in as a Case Manager RN. Working from the comfort of your home in Ohio, you'll play a critical role in making meaningful connections with members, assessing their medical needs, and crafting personalized care plans that promote their overall wellness. With a standard workweek of Monday through Friday, but with some flexibility to cater to member needs, your days will be dynamic and impactful. You'll assess, plan, and implement case management strategies, using your clinical expertise to address both medical and social factors that influence health outcomes. This role involves evaluating member situations through telephonic consultations, reviewing prior claims, and collaborating with various clinical resources when necessary. You'll use your strong assessment skills to help members navigate their healthcare journeys, ensuring they receive the best possible care tailored to their unique circumstances. The satisfaction of contributing to someone’s health and life can be deeply rewarding as you facilitate their transitions and connect them with appropriate programs and resources. Plus, with a supportive company behind you and opportunities for growth and development, CVS Health is not just a job—it's a chance to be part of a caring community that values your skills and contributions. If you're ready to take on this vital role, we would love to hear from you!
Join Oak Street Health as a Nurse Practitioner where you'll provide compassionate primary care to Medicare patients while collaborating with a team of dedicated healthcare professionals.
As a Senior Analyst at CVS Health, you'll play a crucial role in analyzing business requirements and supporting a variety of projects in the dynamic health solutions sector.
Become an essential part of patient care at San Juan Regional Medical Center as a Nephrology Unit Nurse Technician.
Join Mondrian as a Houseperson and play a vital role in maintaining the luxurious experience they offer to guests.
As an Associate Banker, you will represent our brand and support clients in achieving their financial goals through personalized service.
Join Plaza Home Mortgage as a Client Service Representative and play a key role in delivering exceptional customer support and ensuring loans are cleared to close in a timely manner.
Embark on a rewarding internship journey with Veolia North America, where students gain invaluable experience across multiple business functions.
Sanctuary Hospice is looking for a dedicated RN Case Manager to make a meaningful impact in the lives of patients and families in need of hospice care.
Become part of U-Haul's customer service team as a U-Box Customer Care Representative, where the open road is your workplace.
Join Hackensack Meridian Health as a Patient Care Technician in Oncology and help create a better healthcare experience for our patients.
We help people with their health wherever and whenever they need us. And we do it with heart. Because our passion is our purpose: Bringing our heart to every moment of your health™.
1018 jobs
Subscribe to Rise newsletter
🔮
Hi, I'm Risa! Your AI Career Copilot
you, just ask me below!
Sign up for our weekly
newsletter of fresh jobs
