Case Manager Registered Nurse - Field -
About The Position
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. Position Summary This Case Manager (Registered) role supports Aetna’s Long-Term Services and Supports (LTSS) team and is a field‑based position serving the Western Richmond, Virginia region. Candidates must hold a current Virginia Registered Nurse (RN) or Licensed Practical Nurse (LPN)license and be able to travel 50–75% of the time to conduct in‑person member visits. The position includes periods of remote/office‑based work with productivity and quality expectations. Work involves reviewing handwritten and computer‑generated documentation, using a PC for extended periods, and engaging in frequent phone and virtual communication. Role Overview The Case Manager is responsible for assessing, planning, coordinating, and implementing comprehensive case management services to support members’ medical, functional, and social needs. The goal is to enhance both short‑term and long‑term wellness outcomes through proactive care planning and integrated support strategies. Key responsibilities include: Conducting holistic assessments using clinical tools, data review, and member interviews to determine needs, benefit eligibility, and care coordination requirements. Developing individualized care plans to address medical, behavioral, and social factors impacting member health. Identifying risk factors, barriers, and opportunities to improve wellness and reduce health complications. Collaborating closely with internal and external partners to support seamless transitions into Aetna programs and services. Reviewing claims history and clinical information to guide care decisions and evaluate potential case management impact. Presenting complex cases in multidisciplinary conferences and consulting with supervisors to overcome barriers to goals. Ensuring compliance with company policies, regulatory requirements, and case management standards. Using effective interviewing and engagement techniques to understand member needs and encourage active participation in their care plan.
Requirements
- Must reside to the West of Richmond Virginia, including areas such as Ashland, Glen Allen, Henrico and Tuckahoe.
- Reliable transportation and willingness to travel 50–75% of the time (mileage reimbursement provided per company policy).
- Current, unrestricted Virginia LPN, RN, or Behavioral Health license.
- Minimum 3 years of clinical experience (ideally in Medical‑Surgical, Behavioral Health, Long‑Term Care, or related settings).
- 1+ year of Managed Care experience.
- Proficiency in navigating multiple computer systems, strong keyboarding skills, and ability to work in a technology‑driven environment.
Nice To Haves
- Case Management experience within an integrated care model.
- 5+ years of clinical practice.
- Strong ability to multitask, prioritize, and adapt in a fast‑paced, evolving environment.
- Excellent verbal and written communication skills.
- Bilingual (Spanish) strongly preferred.
Responsibilities
- Conducting holistic assessments using clinical tools, data review, and member interviews to determine needs, benefit eligibility, and care coordination requirements.
- Developing individualized care plans to address medical, behavioral, and social factors impacting member health.
- Identifying risk factors, barriers, and opportunities to improve wellness and reduce health complications.
- Collaborating closely with internal and external partners to support seamless transitions into Aetna programs and services.
- Reviewing claims history and clinical information to guide care decisions and evaluate potential case management impact.
- Presenting complex cases in multidisciplinary conferences and consulting with supervisors to overcome barriers to goals.
- Ensuring compliance with company policies, regulatory requirements, and case management standards.
- Using effective interviewing and engagement techniques to understand member needs and encourage active participation in their care plan.
Benefits
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an 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.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
