Case Manager Registered Nurse Job at CVS Health (Work at Home)

Case Manager Registered Nurse

CVS Health

Location:
United States , Work at Home

Category:
Nursing

Contract Type:
Not provided

Salary:

66575.00 - 142576.00 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. Looking specifically for residents in PST due to member demographics and working hours. The RN Case Manager is responsible for conducting telephonic and/or in‑person assessments, developing care plans, and coordinating comprehensive case management services to support members’ medical needs and promote overall wellness.

Job Responsibility:

Develops proactive, individualized care strategies to improve both short‑ and long‑term health outcomes and enhance overall member well‑being through integrated care
Uses clinical tools, data, and member benefit information to assess needs, determine eligibility, and ensure smooth coordination with Aetna programs and services
Applies clinical judgment to implement strategies aimed at reducing risk factors, removing barriers, and addressing complex medical, behavioral, and social determinants that impact care plans
Conducts holistic assessments using diverse information sources to evaluate all conditions, including co‑morbidities and multiple diagnoses that affect daily functioning
Reviews historical claims to identify potential impacts on current case management needs and benefit eligibility
Evaluates members’ functional capacity, including work capabilities and any related restrictions or limitations
Uses a whole‑person approach to determine when referrals to specialized clinical resources are needed to further evaluate functionality
Collaborates with supervisors and interdisciplinary teams to address barriers, support case objectives, and participate in case conferences for comprehensive claim management
Follows established case management protocols in alignment with regulatory requirements and company policies
Utilizes strong interviewing and conversational skills to engage members, accurately identify health status, and understand immediate and long‑term care needs

Requirements:

Active, unrestricted Registered Nurse (RN) license in state of residence
multi‑state/compact licensure preferred
Must be able to obtain licensure in all non‑compact states
Minimum of 3 years of clinical experience
Associate Degree in Nursing required

Nice to have:

Compact RN licensure
Case management experience
Case Manager Certification (e.g., CCM)
Proficiency with Windows and Microsoft Office
Strong computer and documentation skills
Bachelor of Science in Nursing (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
CVS Health bonus, commission or short-term incentive program

Additional Information:

Job Posted:
February 21, 2026

Expiration:
February 28, 2026

Employment Type:

Fulltime

Work Type:

Remote work

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