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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, including assessment, planning, and implementation of care strategies to enhance member wellness. Proficient in utilizing clinical judgment and navigating secure systems while ensuring compliance with regulatory standards.
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
Case ManagementClinical AssessmentCare CoordinationHealth EvaluationClinical JudgmentTechnical TroubleshootingRegulatory ComplianceData ReviewFunctionality AssessmentHealth Status Interviews
Soft Skills
CommunicationCollaborationProblem-SolvingAdaptabilityInterpersonal Skills
Tools & Technologies
Microsoft Office 365Google WorkspaceVPNEHR PortalsMultiple Monitors
Certifications & Qualifications
Certified Case Manager (CCM)
Industry Keywords
Managed CareDischarge PlanningHIPAA ComplianceClinical ResourcesIntegrated Care Model
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 diagnoses
- Facilitate transitions to Aetna programs and plans
- Apply clinical judgment to reduce risk factors and address complex health and social indicators
- Assess work capacity, restrictions, limitations, functionality, and need for clinical-resource referrals
- 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 determine 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
- Willingness and ability to obtain multiple-state RN licensure after hire if needed
- Associate Degree in Nursing
- 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
- Quiet, secure, private designated home virtual work location compliant with CVS Health and HIPAA guidelines
- Ability to work within the state and city where you currently live
- Ability to use multiple monitors and navigate multiple applications
- Experience with Microsoft Office 365 or similar Google Workspace applications
- Ability to access secure systems such as VPN and EHR portals
- Ability to follow computer, password, and information-security practices
- Ability to troubleshoot common technical issues independently
- Preferred: Certified Case Manager (CCM) certification
- Preferred: 3+ years’ experience with Microsoft Office Suite
- Preferred: Case Management in an integrated model
- Preferred: Discharge Planning experience
- Preferred: Managed care experience
- BSN preferred
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.)
- Expenses paid by the company for multiple-state RN licensure obtained after hire