A1A Case Manager RN - Registered Nurse - NC

CVS Health • Columbus, OH

4d • $54,095 - $116,760 • Hybrid

About The Position

The RN Case Manager is part of Aetna One Advocacy (A1A), a fully integrated population health and customer service solution serving Aetna customers and members nationwide. The model combines data-driven processes with clinical expertise and concierge member services to provide high-touch member advocacy throughout members’ health care journeys.

The RN Case Manager assesses, plans, implements, and coordinates case management activities by phone and/or face to face to evaluate members’ medical needs and support their overall wellness. The role uses clinical tools, member information, claims, and benefit eligibility data to develop plans, address health and social barriers, coordinate referrals and transitions to other Aetna programs, and support improved short- and long-term outcomes.

The position requires in-office training and work in High Point, North Carolina. Candidates must live within a commutable distance, typically no more than 45 minutes away. Initial in-office training lasts approximately four months. After training, the role is work from home, with occasional in-office workdays scheduled in advance and at least one in-office day per quarter for further training. Normal hours are 8:00 a.m.–4:30 p.m. Eastern; occasional later shifts are scheduled through a team rotation to meet member needs. There are no weekend shifts, and flexibility for onsite work shifts is required based on business needs. The expected cohort start date is November 9, 2026.

The role requires a quiet, secure, private home workspace that complies with CVS Health and HIPAA guidelines, and a direct wired internet connection meeting the stated speed requirements; Wi-Fi and satellite internet are not permitted. The company provides computer equipment, while the employee supplies workspace furniture. Employees must work within the state and city where they currently live. The position is full-time, with 40 anticipated weekly hours.

Requirements

• Current Registered Nurse with an unrestricted license in the state of residence.
• Upon hire, obtain licenses in all 50 states; candidates must be willing and able to obtain licenses in non-compact states.
• At least 3 years of clinical practice experience as an RN.
• Live within a commutable distance of High Point, North Carolina, typically within 45 minutes.
• Associate degree in Nursing.
• Meet work-from-home requirements, including a direct wired internet connection with at least 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted.
• Maintain a quiet, secure, private, distraction-free home work location compliant with CVS Health and HIPAA guidelines.
• Work within the state and city where currently living.
• Provide workspace furniture, such as a desk or standing desk, and commit to meeting required internet speeds and other work-from-home requirements.
• Be comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.
• Be able to communicate through digital channels, including email, calendar invitations, Teams messaging, and virtual meetings.
• Have experience with Microsoft Office 365 applications or similar tools such as Google Workspace.
• Be able to access and secure systems, including logging into VPNs and EHR portals, locking unattended screens, managing strong passwords, and recognizing suspicious emails or links.
• Be able to resolve common technical issues independently and contact IT for unresolved issues.
• Be open to learning new skills as the workplace environment evolves.

Nice To Haves

• Multi-state or compact RN license privileges.
• Case management experience in an integrated model.
• Certified Case Manager (CCM) certification.
• Oncology experience.
• Bilingual in English and a second language.
• Diabetes Care and Education Specialist qualification.
• Bachelor of Science in Nursing (BSN).

Responsibilities

• Assess, plan, implement, and coordinate case management activities telephonically and/or face to face to evaluate members’ medical needs and support overall wellness.
• Develop proactive courses of action to address member issues, improve short- and long-term outcomes, and identify opportunities to enhance wellness through integration.
• Use clinical tools and information and data review to evaluate member needs and benefit plan eligibility, facilitate integrated functions, and support smooth transitions to Aetna programs and plans.
• Apply clinical judgment to strategies that reduce risk factors and barriers and address complex health and social indicators affecting care planning and resolution of member issues.
• Assess all relevant conditions, including comorbidities and multiple diagnoses that affect functionality, using information from various sources.
• Review prior claims for their potential impact on case management and eligibility.
• Assess members’ work capacity and related restrictions or limitations.
• Use a holistic approach to assess whether referrals to clinical resources are needed to help determine functionality.
• Consult with supervisors and others to overcome barriers to goals and objectives, and present cases at case conferences for multidisciplinary review and overall claim management.
• Use case management processes in compliance with regulatory requirements and company policies and procedures.
• Use interviewing skills to engage members and understand their health status and needs through questions and conversation.

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources supporting physical, emotional, and financial well-being, based on eligibility
• Eligibility for a CVS Health bonus, commission, or short-term incentive program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree