Case Manager, Registered Nurse – Field - Forbes Hospital, PA

CVS Health • Monroeville, PA

4d • Onsite

About The Position

The ACC Case Manager uses a collaborative, member-centered approach to assess, plan, coordinate, evaluate, and advocate for the comprehensive health needs of individuals and families. The role supports appropriate benefits and healthcare services, wellness activities, and successful, timely health outcomes through effective care delivery and member wellness strategies.

This is an on-site, hospital-based position supporting members receiving care at Forbes Hospital. It requires consistent in-person engagement with members, providers, and multidisciplinary care teams, and candidates must live within reasonable driving distance of the facility. The role works with members by phone and in person, including during inpatient admissions, and coordinates care across the continuum to address medical, functional, vocational, behavioral, and social needs.

Requirements

• Active and unrestricted Registered Nurse (RN) license in Pennsylvania.
• At least 3 years of clinical experience; experience with Medicare and commercial populations is preferred.
• Reliable transportation and ability to consistently meet on-site hospital-based work requirements at Forbes Hospital, up to 50–75%.
• Ability to work independently in a hospital-based environment.
• Strong analytical, problem-solving, organizational, and communication skills.
• Proficiency in MS Word, Excel, Outlook, and PowerPoint, as well as proprietary clinical systems.
• Efficient computer skills, including navigating multiple systems and keyboarding.
• Associate’s degree in Nursing with equivalent clinical experience.

Nice To Haves

• At least 3 years of experience in care management, discharge planning, or home health coordination.
• Willingness to obtain multi-state RN licensure; company support is available.
• National certification such as CRC, CDMS, CRRN, COHN, or CCM.
• Bachelor’s degree.

Responsibilities

• Serve as a liaison among members, families, employers, providers, insurance carriers, and healthcare personnel.
• Implement and coordinate case management for catastrophic and chronically ill members across the continuum of care, including referrals, home care, community resources, and alternative levels of care.
• Assess medical, functional, and vocational status and develop and implement individualized plans of care that support optimal outcomes, benefits eligibility, and timely return to work or baseline functioning.
• Communicate effectively with medical providers, attorneys, employers, insurance carriers, and other stakeholders.
• Prepare timely and accurate documentation of case management activities.
• Collaborate with internal multidisciplinary teams to support optimal member outcomes.
• Conduct outreach to treating physicians and specialists to support appropriate care planning.
• Provide education and preventive guidance to promote the best clinical outcomes.
• Apply applicable laws, regulations, and payer requirements related to rehabilitation and case management services.
• Monitor member progress toward desired outcomes and adjust care plans as needed.
• Develop proactive strategies to address complex needs and support short- and long-term wellness outcomes.

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources supporting colleagues’ 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