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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in case management activities, clinical assessment, and care coordination, with a strong focus on improving member health outcomes and compliance with regulatory standards. Proficient in utilizing clinical judgment and technology to facilitate effective communication and collaboration in a remote work environment.
Highest-signal resume keywords
Active RN Licensure2+ Years Clinical ExperienceCertified Case Manager (CCM)Case Management in Integrated ModelDischarge Planning Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical AssessmentCase Management ProcessesHealth Status EvaluationReferral DeterminationCo-Morbidity AssessmentData ReviewClinical JudgmentMicrosoft Office SuiteEHR Portal AccessTroubleshooting Technical Issues
Soft Skills
CommunicationCollaborationProblem-SolvingAdaptabilityInterpersonal Skills
Tools & Technologies
Microsoft Office 365Google WorkspaceVPN AccessTeams MessagingVirtual Meeting Platforms
Certifications & Qualifications
Active RN LicensureCertified Case Manager (CCM)
Industry Keywords
Managed CareEmergency DepartmentHome HealthHospiceICUTelemetryLong Term CareInfusion NursingHIPAA ComplianceCompact States
About the role
Key responsibilities & impact- Assess members telephonically and/or face to face
- Plan, implement, and coordinate case management activities
- Evaluate members’ medical needs to facilitate overall wellness
- Develop proactive courses of action to improve short- and long-term outcomes
- Review clinical tools, information, data, prior claims, benefit eligibility, and member needs
- Facilitate 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
- Determine need for referrals to clinical resources
- Consult with supervisors and others to overcome barriers
- Present cases at multidisciplinary case conferences
- Use case management processes in compliance with regulatory and company policies
- Conduct interviews to engage members and assess health status and needs
Requirements
What you’ll need- Active RN licensure in the state where you reside
- 2+ years of clinical experience as an RN
- All clinical experience will be considered, including Emergency Department, Home Health, Hospice, Operating Room, ICU, NICU, Telemetry, Medical / Surgical, Orthopedics, Long Term Care, and Infusion nursing
- Multiple State RN licensure welcomed but not required; willingness and ability to obtain multiple state RN licensure after hire if chosen
- Associates Degree in Nursing
- Certified Case Manager (CCM) certification preferred
- Preference for candidates who reside in compact states
- 3+ years’ experience with Microsoft Office Suite preferred
- Case Management in an integrated model preferred
- Discharge Planning experience preferred
- Managed care experience preferred
- BSN preferred
- Direct/hardwired internet connection to a modem/router within 7 feet of the computer
- Minimum internet speed of 25 Mbps download and 3 Mbps upload
- WiFi and satellite internet are not permitted
- Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines
- Must work within the state and city where currently residing
- Ability to use multiple monitors and multiple applications
- Ability to use email, calendar invites, Teams messaging, and virtual meetings
- Experience with Microsoft Office 365 applications or similar Google Workspace tools
- Ability to access secure systems such as VPN and EHR portals
- Ability to follow computer, password, and email security practices
- Ability to troubleshoot common technical issues independently
- Willingness to learn new skills as the workplace evolves
Benefits
Comp & perks- CVS Health bonus, commission or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources supporting physical, emotional, and financial well-being
- Company-provided equipment (keyboard, monitor, computer, headset, etc.)
- Company-paid expenses for obtaining multiple state RN licensure after hire, if needed