[Hiring] Case Manager - Registered Nurse @CVS Health

Role Description

This Case Manager - Registered Nurse (RN) position is with Aetna’s National Medical Excellence (NME) team and is a fully remote position. Candidates from any state are welcome to apply, however, preference is for candidates in compact Registered Nurse (RN) states.

This role is a blended role doing both Case Management and Utilization Management. The RN Case Manager 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.

• 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.
• Conducts an evaluation of member’s needs and benefit plan eligibility through the use of clinical tools and information/data review.
• Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators impacting care planning.
• Reviews prior claims to address potential impact on current case management and eligibility.
• Assesses the member’s level of work capacity and related restrictions/limitations.
• Uses a holistic approach to assess the need for a referral to clinical resources for assistance in determining functionality.
• Consults with supervisor and others to overcome barriers in meeting goals and objectives.
• 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.

Qualifications

• Active, current and unrestricted compact Registered Nurse (RN) licensure in the state of residence.
• 5 years clinical practice experience as a Registered Nurse (RN).
• 2+ years’ experience in critical care.
• 6+ months case management or utilization management experience.
• Must be able to work Monday - Friday 8 AM to 5 PM in the time zone of residence.
• Must be able to obtain multi-state Registered Nurse (RN) licensures.

Preferred Qualifications

• Case Management Certification.
• Transplant experience.

Education

• Associate's Degree in Nursing (REQUIRED).
• Bachelor's Degree in Nursing (PREFERRED).

Work from Home Requirements

• Must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer with a minimum download speed of 25 Mbps and 3 Mbps upload.
• A quiet, secure, and private designated home virtual work location, compliant with CVS Health and HIPAA guidelines.
• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
• The company will provide equipment (keyboard, monitor, computer, headset, etc.).
• Commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical and Logistical Requirements

• Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.
• Ability to communicate on digital channels such as email, calendar invites, Teams messaging, and virtual meetings.
• Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar.
• Ability to log in to secure systems (e.g., VPN, EHR portal) and manage strong passwords.
• Ability to resolve common technical issues independently.
• Openness to learning new skills as the workplace environment evolves.

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.

Benefits

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.
• Other resources, based on eligibility.