RN Case Manager, CVS Health

CVS Health

Location:
United States, High Point

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

54095.00 - 116760.00 USD / Year

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Job Description:

The RN Case Manager role is part of Aetna One Advocacy (A1A) and requires in office training and ongoing work in High Point, NC. This position is responsible for telephonically and/or face-to-face assessing, planning, implementing, and coordinating all case management activities with members to evaluate their medical needs and overall wellness through integration. It involves using clinical tools, reviewing data, and employing strategies to reduce risk factors and barriers impacting members' care plans.

Job Responsibility:

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 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
reviews prior claims to address potential impact on current case management and eligibility
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
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:

A Registered Nurse that must hold an unrestricted license in their state of residence, preferably with multi-state/compact privileges and be willing and able to be licensed in all non-compact states
upon hire, it will be required to obtain all 50 state licenses
3+ years of clinical practice experience required as an RN
There is a requirement to live within a commutable distance of High Point, NC (typically within 45 minutes maximum).

Nice to have:

Case Management in an integrated model
Certified Case Manager (CCM) certification.

What we offer:

Affordable medical plan options
401(k) plan (including matching company contributions)
employee stock purchase plan
no-cost programs 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:
August 26, 2025

Expiration:
August 29, 2025

Employment Type:

Fulltime

Work Type:

Hybrid work

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RN Case Manager