Case Manager, Registered Nurse - Field (Boone/McHenry Counties, IL)

CVS Health•Crystal Lake, IL

1d•$66,575 - $142,576•Hybrid

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. Help us elevate patient care to a whole new level. Join Aetna, an industry leader in serving dual-eligible populations through best-in-class clinical and operational models. In this role, you will have a meaningful impact on members enrolled in both Medicare and Medicaid who face complex medical, behavioral, and social challenges. Through compassionate support and effective communication, we partner with members, providers, caregivers, and community organizations to address the full spectrum of healthcare and social determinant needs. As we continue to grow and expand into new markets across the country, we invite you to join us in transforming lives and improving health outcomes. The Care Manager RN uses a collaborative, member-centered approach to assess, plan, coordinate, implement, monitor, and evaluate healthcare services. This role partners with members and their families to address comprehensive health needs, facilitate access to appropriate resources, and promote quality, cost-effective outcomes. The Care Manager develops and implements individualized care plans that support wellness, optimize clinical outcomes, and ensure members receive the appropriate benefits, services, and support needed to achieve their health goals.

Requirements

Candidates must live in Boone or McHenry Counties and be a resident of Illinois
Must possess reliable transportation and be willing and able to travel up to 50-75% of the time. Mileage is reimbursed per our company expense reimbursement policy
Active and unrestricted Registered Nurse (RN) license in IL
Minimum of 3-5 years of clinical nursing experience.
Minimum of 2-3 years of experience in case management, discharge planning, care coordination, or home health.
Strong clinical assessment, critical thinking, and problem-solving skills.
Excellent communication, organizational, and interpersonal skills.
Ability to work independently and effectively in a remote environment.
Comfortable use of technology to collaborate virtually with interdisciplinary teams.
Ability to travel within an assigned geographic area to conduct in-person member visits and care management activities as needed.
Proficiency in Microsoft Office applications, including Word, Excel, Outlook, and PowerPoint, as well as care management and documentation systems.
Strong computer skills with the ability to navigate multiple systems simultaneously.

Nice To Haves

Certified Case Manager (CCM) certification.
Experience working with Medicare, Medicaid, or dual-eligible populations.
Experience in addressing social determinants of health and coordinating community-based services.

Responsibilities

Serve as a liaison among members, families, providers, employers, health plans, community organizations, and other key stakeholders.
Coordinate and manage care activities for members with complex, chronic, catastrophic, or acute health conditions across the continuum of care.
Conduct comprehensive assessments to evaluate medical, functional, psychosocial, and environmental needs.
Develop, implement, and monitor individualized care plans designed to improve health outcomes and support member wellness.
Facilitate access to appropriate healthcare services, community resources, home health services, and alternative levels of care.
Engage with members telephonically and through in-person visits in homes, provider offices, or community settings as needed.
Collaborate with interdisciplinary care teams to ensure coordinated, evidence-based care.
Communicate effectively with providers, members, caregivers, and other stakeholders regarding treatment plans, progress, and care needs.
Educate members and families on disease management, prevention strategies, available benefits, and community resources.
Conduct outreach to treating physicians, specialists, and other providers to support care coordination and treatment planning.
Monitor member progress and adjust care plans as needed to achieve desired outcomes.
Maintain accurate and timely documentation of case management activities in accordance with organizational, regulatory, and accreditation requirements.
Ensure compliance with all applicable laws, regulations, policies, and case management standards.
Promote optimal health outcomes, functional independence, and quality of life through proactive intervention and advocacy.