CVS Health is looking for a Case Manager - Registered Nurse (RN) to join Aetna’s National Medical Excellence (NME) team. This fully remote position is responsible for assessing, planning, implementing, and coordinating case management activities to evaluate member medical needs and facilitate overall wellness through telephonic and face-to-face interactions.
What You'll Do
- Develop proactive courses of action to address issues and enhance short and long-term outcomes and member wellness.
- Conduct evaluations of member needs and benefit plan eligibility, facilitating integrative functions and smooth transitions to Aetna programs.
- Apply clinical judgment to incorporate strategies that reduce risk factors and barriers and address complex health and social indicators.
- Consider information from various sources to address all conditions, including co-morbid and multiple diagnoses impacting functionality.
- Review prior claims to address potential impact on current case management and eligibility.
- Assess the member’s level of work capacity and related restrictions or limitations.
- Use a holistic approach to assess the need for referrals to clinical resources for assistance in determining functionality.
- Consult with supervisors and present cases at conferences to overcome barriers and benefit overall claim management.
- Utilize case management processes in compliance with all regulatory and company policies.
- Utilize interviewing skills to ensure maximum member engagement and discern health status and needs.
What We're Looking For
- Active, current, and unrestricted compact Registered Nurse (RN) licensure in your state of residence.
- 5 years of clinical practice experience as a Registered Nurse (RN).
- 2+ years of experience in critical care.
- 6+ months of case management or utilization management experience.
- Ability to work Monday through Friday, 8 AM to 5 PM in your time zone of residence.
- Ability to obtain multi-state Registered Nurse (RN) licensures.
- Associate's Degree in Nursing.
Nice to Have
- Case Management Certification.
- Transplant experience.
- Bachelor's Degree in Nursing.
Team & Environment
You will be part of Aetna’s National Medical Excellence (NME) team.
Benefits & Compensation
- Compensation: $60,522.00 - $129,615.00
- Affordable medical plan options
- 401(k) plan with matching company contributions
- Employee stock purchase plan
- No-cost programs for all colleagues including wellness screenings, tobacco cessation, weight management, counseling, and financial coaching
- Paid time off
- Flexible work schedules
- Family leave
- Dependent care resources
- Colleague assistance programs
- Tuition assistance
- Retiree medical access
Work Mode
This is a fully remote position open to candidates in any state in the US.
CVS Health is an equal opportunity employer. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
