Case Manager

CVS Health

. Assess, plan, implement, and coordinate case management activities telephonically and/or face to face .

Posted 10/12/2026full-timeRemote • Idaho • United StatesMid-LevelSenior💰 $54,095 - $116,760 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in case management activities, including assessing and planning for member needs, applying clinical judgment, and facilitating transitions to healthcare programs. Holds a Registered Nurse license and possesses strong clinical practice experience, with a focus on compliance and effective communication.

Highest-signal resume keywords

Registered Nurse LicensureCase Management ExperienceClinical Practice ExperienceBilingual (English/Spanish)Case Manager Certification

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentCare CoordinationRisk Factor ReductionData ReviewHealth Status Evaluation

Soft Skills

CommunicationInterpersonal SkillsProblem-Solving

Tools & Technologies

Microsoft OfficeWindows

Certifications & Qualifications

Case Manager Certification

Industry Keywords

Case ManagementHealthcare ProgramsRegulatory ComplianceCo-MorbiditiesClinical Judgment

About the role

Key responsibilities & impact

Assess, plan, implement, and coordinate case management activities telephonically and/or face to face
Evaluate members’ medical needs to facilitate overall wellness
Develop proactive courses of action to enhance short- and long-term outcomes
Evaluate member needs and benefit plan eligibility using clinical tools and information/data review
Facilitate integrative functions and transitions to Aetna programs and plans
Apply clinical judgment to reduce risk factors and address complex health and social indicators
Assess co-morbidities, multiple diagnoses, functionality, work capacity, and restrictions or limitations
Review prior claims and assess the need for clinical resource referrals
Consult with supervisors and participate in multidisciplinary case conferences
Use case management processes in compliance with regulatory and company policies
Conduct interviews to engage members and determine health status and needs

Requirements

What you’ll need

Registered Nurse with active and unrestricted RN licensure in their state of residence
Preferably multi-state/compact privileges
Must have the ability to be licensed in all non-compact states
3+ years clinical practice experience required
Associate's degree required
Compact RN licensure preferred
Case management experience preferred
Case Manager Certification preferred
Experience with Windows / Microsoft Office preferred
Strong computer skills preferred
Bilingual (English/Spanish) speaking preferred

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being
CVS Health bonus, commission or short-term incentive program in addition to base pay