A1A Case Manager RN - Registered Nurse - NC

CVS Health • High Point, NC

129d • $54,095 - $116,760 • Remote

About The Position

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. This RN Case Manager role is part of Aetna One Advocacy (A1A) and requires in office training and ongoing work in High Point, NC. There is a requirement to live within a commutable distance of High Point, NC (typically within 45 minutes maximum). The expected start date for the cohort is October 13, 2025. The initial in office training will last for approximately 4 months. Once office training is complete, the role is work from home with occasional in office workdays scheduled in advance with the employee. There will be an expectation that the Case Manager works in the office at least one time per quarter for further training but it may be more often and notice will be provided. Normal Working Hours: 8am-4:30pm EST. Once training is completed, the Case Manager will work occasional later shifts per month on a team rotation. There are no weekend shifts. Flexibility is required for onsite work shifts per the need of the business.

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 Haves

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

Responsibilities

• 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.
• Assesses 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.
• Assesses the member's level of work capacity and related restrictions/limitations.
• Uses a holistic approach to 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.

Benefits

• 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.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Ambulatory Health Care Services
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees