Case Manager Registered Nurse
About The Position
CVS Health is seeking an experienced Registered Nurse Case Manager for Aetna National Medical Excellence. This blended Case Management and Utilization Management role supports members with complex healthcare needs. The nurse partners with members, providers, and interdisciplinary teams to develop personalized care plans, improve health outcomes, reduce barriers to care, and promote wellness. The opportunity is fully remote and open to candidates nationwide, with preference for nurses residing in compact licensure states. The role requires working Monday through Friday, 8:00 AM–5:00 PM in the employee’s local time zone. Weekend and holiday work may depend on business needs, although the posting says these are not currently required. The employer provides work equipment, while employees provide their own desk or standing desk and meet the stated secure home-workspace and hardwired internet requirements. The position is full-time, with 40 anticipated weekly hours.
Requirements
- Active, unrestricted Compact RN license in the state of residence.
- At least 5 years of RN clinical practice experience.
- At least 2 years of critical care experience.
- At least 6 months of Case Management or Utilization Management experience.
- Ability to work Monday through Friday, 8:00 AM–5:00 PM in the local time zone; weekends and holidays may be based on business needs.
- Willingness to obtain additional state RN licenses; the company pays for these licenses.
- Associate Degree in Nursing.
- Ability to meet work-from-home requirements, including a direct/hardwired internet connection with minimum speeds of 25 Mbps download and 3 Mbps upload; WiFi and satellite internet are not permitted.
- Ability to maintain a quiet, secure, private, and HIPAA-compliant designated home workspace and work within the state and city where the employee currently lives.
- Ability to use multiple monitors and applications and communicate through digital channels such as email, calendar invites, Teams messaging, and virtual meetings.
- Ability to use Microsoft Office 365 or similar applications, access secure systems such as VPN and EHR portals, follow basic security practices, and troubleshoot common technical issues.
- Openness to learning new skills as the workplace environment evolves.
Nice To Haves
- Case Management Certification (CCM or equivalent).
- Transplant nursing experience.
- Bachelor of Science in Nursing (BSN).
Responsibilities
- Assess, coordinate, and manage care for members with complex medical needs.
- Develop proactive care plans to improve short- and long-term health outcomes.
- Identify clinical, social, and functional barriers that affect care.
- Collaborate with healthcare providers and multidisciplinary teams.
- Use clinical judgment to support utilization and care management decisions.
- Engage members through telephonic care management and health coaching.
Benefits
- Medical, dental, and vision coverage.
- Paid time off.
- Retirement savings options.
- Wellness programs and other resources, based on eligibility.
- Eligibility for a CVS Health bonus, commission, or short-term incentive program.
- Company-sponsored multi-state licensure.
- Company-provided work equipment, including keyboard, monitor, computer, and headset.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
