Case Manager, RN

CVS Health

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

Posted 11/12/2026full-timeRemote • Pennsylvania • 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 assessing and coordinating care for members, applying clinical judgment, and facilitating transitions to integrated health programs. Holds active RN licensure and possesses strong clinical experience, with a focus on improving health outcomes and managing complex cases.

Highest-signal resume keywords

Active RN LicensureClinical ExperienceCertified Case Manager (CCM)Case ManagementMicrosoft Office Suite

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case Management ActivitiesClinical AssessmentCare CoordinationDischarge PlanningRisk Factor ReductionData ReviewHealth Status EvaluationInterviewing SkillsCo-Morbidity AssessmentIntegrated Model Experience

Soft Skills

Communication SkillsInterpersonal SkillsTeam CollaborationProblem-Solving SkillsAdaptability

Certifications & Qualifications

Certified Case Manager (CCM)

Industry Keywords

Managed CareRegulatory ComplianceClinical ResourcesBenefit Plan EligibilityMultidisciplinary Case Conferences

About the role

Key responsibilities & impact

Assess, plan, implement, and coordinate case management activities with members 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, information, data, benefit plan eligibility, and prior claims
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
Refer members to clinical resources when needed
Consult with supervisors and participate in multidisciplinary case conferences
Follow regulatory and company case management policies and procedures
Use interviewing skills to engage members and determine health status and needs

Requirements

What you’ll need

Active, current and unrestricted RN licensure in the state of residence
Multiple State RN licensure welcomed but not required; willingness and ability to obtain multiple state RN licensure after hire if chosen
2+ years of clinical experience as an RN
3+ years’ experience with Microsoft Office Suite
Willingness and ability to work Monday through Friday, 9:00am–5:30pm EST
Willingness and ability to work occasional evening, weekend, and holiday shifts as needed
Associates Degree required
Certified Case Manager (CCM) certification preferred
Case Management in an integrated model preferred
Discharge Planning experience preferred
Managed care experience 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-paid expenses for obtaining multiple state RN licensure after hire, if chosen