[Hiring] Case Manager Registered Nurse - Single Point of Contact @CVS Health

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

Aetna is hiring a Single Point of contact (Dedicated Clinical Advocate) to support one of our premier healthcare clients. In this role, you will drive member engagement, optimize care delivery, and influence benefit strategies. Acting as a trusted advisor, you will connect members to resources, remove barriers to care, and deliver measurable improvements in health outcomes.

Key responsibilities include:

• Serve as a primary contact for members, guiding them through benefits and care options for a seamless experience.
• Promote holistic well-being through initiatives focused on physical and mental health.
• Proactively engage high-cost claimants and frequent ER users, educating on appropriate care settings and facilitating PCP connections.
• Monitor out-of-network utilization and educate members on cost-effective, in-network care options.
• Coach members with chronic conditions, set personalized health goals, and connect them to Aetna One Flex Nurse for ongoing support.
• Act as client lead with case management teams, aligning care strategies with client culture and goals.
• Ensure smooth Transition of Care for new members and refer to specialized programs (e.g., 2nd MD, Health Advocate, Lantern, EAP).
• Leverage data analytics to identify gaps in care and design targeted outreach strategies to close those gaps.
• Review appeals and denials to identify policy improvement opportunities that remove barriers to care.
• Analyze utilization data and collaborate with account teams to develop actionable clinical and benefit strategies.
• Lead high-cost claimant reviews and implement targeted population health initiatives
• Partnering with the plan sponsor and Aetna account team to address concerns, resolve issues, and manage high-cost claimants in collaboration with external vendors as needed.
• Conducting proactive outreach to targeted populations to support care coordination and improve health outcomes.
• Serving as the direct contact for plan escalations and benefit-related inquiries from members or the plan sponsor.
• Educating internal and external stakeholders on narrow network utilization and home-host steerage strategies.
• Collaborating with Utilization Management on complex cases to ensure seamless care transitions.
• Reviewing reports from the account team and CPC to identify outreach opportunities, support domestic steerage, and analyze data for improved member engagement.
• Participating in annual utilization reviews with the account team and key plan sponsor stakeholders.
• Supporting special projects as assigned by HBS Leadership, the Account Team, or the Plan Sponsor.
• Traveling to plan sponsor healthcare facilities (approximately 10–15%) for annual meetings, collaboration sessions, or open enrollment events as requested.

Required Qualifications

• with in the field.
• , demonstrating effective coordination and patient advocacy.
• Proficient in , with the ability to assess situations and implement appropriate solutions.
• Strong skills.
• Ability to environment.
• Proven to interpret data and identify opportunities.
• Resolution-focused with and collaborative problem-solving skills.
• to meet member needs, including early mornings or evenings.
• Solid understanding of and its application in clinical settings.
• Demonstrated , including the use of electronic health records and other healthcare technologies.
• Strong interpersonal skills with the ability to communicate with patients, families, and community members.
• Proven ability to manage with integrity, confidentiality, and ethical responsibility.
• Skilled in evaluating of various options to determine the most effective course of action.
• Capable of working effectively in , respecting cultural differences among staff and patients.
• Based on location there may be on a very limited basis. Must possess reliable transportation and be willing and able to travel. Mileage is reimbursed per our company expense reimbursement policy

Preferred Qualifications

• Certified Case Manager Certification
• Proven ability to manage and coordinate in a dynamic environment.
• Exceptional , with the ability to convey complex information clearly and effectively.
• , with a strong aptitude for identifying trends and insights.
• , demonstrating effective planning, execution, and stakeholder engagement.
• , with a track record of guiding teams, driving initiatives, and fostering collaboration.

Education

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The typical pay range for this role is:

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.

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:

• a (including matching company contributions), and an .

• including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• 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

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