Case Manager - Registered Nurse, CVS Health

CVS Health

Location:
United States, Chester County + Lancaster

Category:
Nursing

Contract Type:
Employment contract

Salary:

60522.00 - 129615.00 USD / Year

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Job Description:

Community Care Case Manager's use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost effective outcomes. Join our Community Care team as an industry leader in serving our members by utilizing best-in-class operating and clinical models.

Job Responsibility:

Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities
Develops, implements, and supports Health Strategies, tactics, policies, and programs that ensure the delivery of benefits
Use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs
Acts as a liaison with member/client/family, employer, provider(s), insurance companies, and healthcare personnel as appropriate
Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care
Interacts with members/clients telephonically or in person
Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status
Develops a plan of care to facilitate the member/client's appropriate condition management
Communicates with member/client and other stakeholders as appropriate
Prepares all required documentation of case work activities
Interacts and consults with internal multidisciplinary team as indicated
May make outreach to treating physician or specialists concerning course of care and treatment
Provides educational and prevention information for best medical outcomes
Applies all laws and regulations that apply to the provision of rehabilitation services
Testifies as required to substantiate any relevant case work or reports
Conducts an evaluation of members/clients' needs and benefit plan eligibility
Utilizes case management processes in compliance with regulatory and company policies and procedures
Facilitates appropriate condition management, optimize overall wellness and medical outcomes
Develops a proactive course of action to address issues presented
Monitors member/client progress toward desired outcomes through assessment and evaluation

Requirements:

Active and unrestricted Pennsylvania Registered Nurse License
Willing to travel 55-75% within designated areas (Penn Med Health System - Chester County Hospital + Lancaster General Hospital)
3+ years of clinical practical experience preference: (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac)
2+ years of case management, discharge planning, and/or home health care coordination experience
Associate's Degree in Nursing or Nursing Diploma (REQUIRED)
Bachelor's Degree in Nursing (PREFERRED)
Active and unrestricted Pennsylvania Registered Nurse License

Nice to have:

Excellent analytical and problem-solving skills
Effective communications, organizational, and interpersonal skills
Ability to work independently (may require working from home)
Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications
Efficient and effective computer skills including navigating multiple systems and keyboarding
Certified Case Manager
National professional certification (CRC, CDMS, CRRN, COHN, or CCM)
Bachelor's Degree in Nursing

What we offer:

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
November 21, 2025

Expiration:
November 30, 2025

Employment Type:

Fulltime

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Case Manager - Registered Nurse