Case Manager, Registered Nurse

CVS Health

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

Posted 10/6/2026full-timeRemote • United StatesJuniorMid-Level💰 $60,522 - $129,615 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in case management activities, including assessment, planning, and implementation of care strategies to enhance member wellness. Proficient in utilizing clinical judgment and regulatory compliance to address complex health needs and facilitate transitions to care programs.

Highest-signal resume keywords

Active RN Licensure2+ Years Clinical ExperienceCertified Case Manager (CCM)Case Management ProcessesMicrosoft Office 365

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case ManagementClinical AssessmentCare CoordinationDischarge PlanningHealth EvaluationRisk Factor ReductionData ReviewReferral DeterminationCo-Morbidity AssessmentFunctionality Evaluation

Soft Skills

CommunicationProblem-SolvingCollaborationInterpersonal SkillsAdaptability

Tools & Technologies

Microsoft Office 365Google WorkspaceVPNEHR PortalsTeams Messaging

Certifications & Qualifications

Active RN LicensureCertified Case Manager (CCM)

Industry Keywords

Managed CareHIPAA ComplianceIntegrated Care ModelClinical ToolsBenefit Plan Eligibility

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 improve short- and long-term outcomes
Review clinical tools and information/data to evaluate member needs and benefit plan eligibility
Facilitate integration 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 their potential impact on case management and eligibility
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 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
Multiple state RN licensure welcomed but not required; if chosen, willingness and ability to obtain it after hire
Associates Degree in Nursing
Ability to work Monday through Friday, 9:00am–5:30pm in the time zone of residence
Availability for occasional evening, weekend, and holiday shifts
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 work location compliant with CVS Health and HIPAA guidelines
Ability to work within the state and city where currently residing
Ability to provide own workspace furniture
Ability to use multiple monitors and navigate multiple applications
Experience with Microsoft Office 365 or similar Google Workspace applications
Ability to use email, calendar invites, Teams messaging, and virtual meetings
Ability to log in to secure systems such as VPN and EHR portals
Ability to follow computer security practices, including strong passwords and recognizing suspicious emails or links
Ability to troubleshoot common technical issues
Preferred: Certified Case Manager (CCM) certification
Preferred: residence in a compact state
Preferred: 3+ years’ experience with Microsoft Office Suite
Preferred: case management in an integrated model
Preferred: discharge planning experience
Preferred: managed care experience
Preferred: BSN

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