Case Manager Registered Nurse

$60,522 - $129,615 / year

Position Summary

This RN Case Manager role is 10 0% remote, and the employee can live in any state and telework, however, there is a preference for an RN in a Compact RN state.

Normal hours are Monday through Friday 8:00am – 4:30pm in the time zone of residence with occasional late shift rotation until 8:00pm. Employees can flex their 8-hour shift between 8:00am-6:00pm.

There are no weekends or holiday shifts required at this time.

Travel of less than 5% may be required in the event of clinical audits.

The RN Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.

RN Case Manager:

– Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration.

– Through the use of clinical tools and information/data review, conducts an evaluation of member’s needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.

– Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.

– Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.

– Reviews prior claims to address potential impact on current case management and eligibility.

– Assessments include the member’s level of work capacity and related restrictions/limitations.

– Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.

– Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.

– Utilizes case management processes in compliance with regulatory and company policies and procedures.

– Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Required Qualifications

- Must have an active current and unrestricted RN license in state of residence

- Willingness and ability to obtain additional state licenses upon hire (paid for by the company)

- 3+ years of acute hospital clinical experience as an RN (general medical, post-surgical, ICU experience).

- Travel of less than 5% may be required in the event of clinical audits.

- Normal hours are Monday through Friday 8:00am – 4:30pm in the time zone of residence with occasional late shift rotation until 9:00pm. Employees can flex their 8-hour shift between 8:00am-6:00pm.

Preferred Qualifications

- 1+ years of case management and/or Home Health experience

- Compact RN licensure

- Certified Case Manager (CCM) certification

- Experience with all types of Microsoft Office including PowerPoint, Excel, and Word

- Strong telephonic communication skills

Education

Associate’s degree in nursing required

BSN preferred

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$60,522.00 - $129,615.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 04/30/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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