Case Manager Registered Nurse Job at CVS Health

Case Manager Registered Nurse

CVS Health

Location:
United States

Category:
Nursing

Contract Type:
Not provided

Salary:

60522.00 - 129615.00 USD / Year

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Job Description:

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. This Case Manager RN position is a fully remote position. Candidates from any state are welcome to apply, however, preference is for candidates in compact RN states. Normal Working Hours: Monday-Friday 8:00am - 6:00pm (8:00am being the earliest start time) in the time zone of residence. Team is open to varying hours until 9:00pm EST. There is a late shift rotation until 9:00pm EST and holiday on-call as needed. There is no travel expected with this position.

Job Responsibility:

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
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

Requirements:

Must be a Registered Nurse with active current and unrestricted RN licensure in state of residence
Must have the ability to obtain multi-state/compact licensure and the ability to be licensed in all states
3+ years clinical practice experience as an RN required
Must be willing to work Monday through Friday 8:00am - 6:00 pm (8:00am being the earliest start time) in the time zone of residence
Requires strong technical skills for working with multiple monitors and programs, proficiency with MS Office Suites (Outlook, Word, Excel)
Associates degree in nursing required

Nice to have:

Compact RN licensure
Case management experience
Case Manager Certification
BSN preferred

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:
February 22, 2026

Expiration:
March 28, 2026

Employment Type:

Fulltime

Work Type:

Remote work

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