Remote RN Jobs

RN Telehealth Full-time
CVS Health

Case Manager Registered Nurse

CVS Health PA
$54,095 - $129,615 / year
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Case Manager RN (100% Remote – Nationwide) Full‑Time | Work from Anywhere Nationwide | No Travel Required We’re seeking a compassionate and results‑driven Case Manager RN to support members through personalized, high‑quality care coordination. In this fully remote role, you’ll use clinical expertise, data‑driven insights, and strong advocacy to help members achieve optimal, cost‑effective health outcomes. What You’ll Do Conduct comprehensive clinical assessments and identify care coordination needs Develop, implement, and monitor individualized case management plans Support inpatient review and discharge planning as appropriate Advocate for members to maximize benefits and access appropriate services Engage members through coaching, education, and motivational interviewing Identify and escalate quality‑of‑care concerns Deliver exceptional customer experience while collaborating with care teams and Medical Directors Schedule Monday–Friday, 9:00 AM–5:30 PM (your local time zone) Occasional rotating late shift as needed ( 11:30 AM–8:00 PM EST ) Required Qualifications Active, unrestricted RN license in your state of residence Willingness to obtain additional state licenses (company paid) 3+ years of acute care RN experience (Med‑Surg or Critical Care preferred) Strong clinical judgment, decision‑making, and organizational skills Preferred Qualifications Compact or multi‑state RN license Certified Case Manager (CCM) Telephonic case management or telephonic clinical experience Education Associate Degree in Nursing (required) BSN (preferred) Why Join Us? 100% remote—live in any state No travel required Meaningful work improving member health and outcomes Supportive, collaborative team environment Apply today to bring your RN expertise to a flexible, impactful case management role. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $54,095.00 - $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: 05/02/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
RN Telehealth Full-time
CVS Health

Case Manager Registered Nurse

CVS Health OH
$60,522 - $129,615 / year
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary This RN Case Manager role is 100% 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 8:00pm. 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 40 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.
RN Telehealth Full-time
CVS Health

Case Manager Registered Nurse

CVS Health
$60,522 - $129,615 / year
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary This RN Case Manager role is 100% 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 9:00pm. 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 8:00pm. 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 40 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.
RN Telehealth Full-time
CVS Health

Case Manager Registered Nurse

CVS Health
$60,522 - $129,615 / year
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. 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 40 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.
RN Telehealth Full-time
CVS Health

Remote Registered Nurse Case Manager (NY RN License Required)

CVS Health New York, NY
$66,575 - $142,576 / year
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Summary: The Care Manager—Registered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible for coordinating care for members who often face multiple chronic medical and behavioral health conditions, as well as various social determinants of health (SDoH) needs. This role involves conducting comprehensive assessments to evaluate members’ needs and addressing SDoH challenges by connecting them with appropriate resources and support services. The Social Worker provides education and guidance to members and their families on managing chronic conditions and navigating the healthcare system. Additionally, the Care Manager develops and implements individualized care plans, monitors member progress, advocates for necessary services, and collaborates with the interdisciplinary care team to ensure optimal health outcomes. Accurate and timely documentation of assessments and interventions is essential, as is participation in team meetings to discuss member status and care strategies. Key Responsibilities: 50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care. Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member’s identified needs. Provides evidence-based disease management education and support to help the member achieve health goals. Ensure the appropriate members of the interdisciplinary care team are involved in the member’s care. Provides care coordination to support a seamless health care experience for the member. Meticulous documentation of care management activity in the member’s electronic health record. Collaborate with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition. Identifies and connects members with health plan benefits and community resources. Meets regulatory requirements within specified timelines. The Care Manager RN supports other members of the Care Team through clinical decision making and guidance as needed. Additional responsibilities as assigned by leadership to support team objectives, enhance operational efficiency, and ensure the delivery of high-quality care to members. This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members. Essential Competencies and Functions: Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements of this role. Conduct oneself with integrity, professionalism, and self-direction. Experience or a willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care. Familiarity with community resources and services. Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records. Maintain strong collaborative and professional relationships with members and colleagues. Communicate effectively, both verbally and in writing. Excellent customer service and engagement skills. Required Qualifications Must have active and unrestricted Registered Nurse (RN) licensure in the state of NY Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the CM RN role. Access to a private, dedicated space to conduct work effectively to meet The requirements of the position. Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually. Minimum 3+ years of nursing experience Minimum 2+ years of case management, discharge planning and/or home healthcare coordination experience Preferred Qualifications Experience providing care management for Medicare and/or Medicaid members. Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health. Experience conducting health-related assessments and facilitating the care planning process. Bilingual skills, especially English-Spanish Education Associate’s of Science in Nursing (ASN) degree and relevant experience in a health care-related field (REQUIRED) Bachelor’s of Science in Nursing (BSN) (PREFERRED) License Must have active and unrestricted Registered Nurse (RN) licensure in the state of NY Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $66,575.00 - $142,576.00 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: 04/22/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
RN Telehealth Full-time
CVS Health

Case Manager Registered Nurse

CVS Health AZ
$60,522 - $129,615 / year
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary: The Case Manager RN role is 100% remote work from home and candidates must have an active RN licensure (any state). Normal Working Hours: Monday through Friday 9:00am – 5:30pm in time zone of residence. Occasional evening, weekend, and holiday shifts per the needs of the team. No travel is expected with this position. 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 RN licensure in the state where you reside. -Multiple State RN licensure is welcomed but not required. If chosen must be willing and able to obtain multiple state RN licensure after hire (expenses paid for by company) -2+ years of clinical experience as an RN -All clinical experience will be considered, such as Emergency Department, Home Health, Hospice, Operating Room, ICU, NICU, Telemetry, Medical / Surgical, Orthopedics, Long Term Care, and Infusion nursing. Preferred Qualifications -Certified Case Manager (CCM) certification -Prefer candidates who reside in compact states. -3+ years’ experience with Microsoft Office Suite -Case Management in an integrated model -Discharge Planning experience -Managed care experience -BSN preferred Education -Associates Degree in Nursing Anticipated Weekly Hours 40 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: 04/21/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
RN Telehealth Full-time
CVS Health

Case Manager - Registered Nurse

CVS Health NJ
$60,522 - $142,576 / year
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Help us elevate our patient care to a whole new level! Join our Community Care team as an industry leader in serving our members by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Community Care members. Community Care is a member centric, team-delivered, community-based care management model that joins members where they are. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country. Family Summary/Mission Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies. Position Summary/Mission Community Care Case Manager use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes. Required Qualifications Candidate must have an active and unrestricted Compact Registered Nurse (RN) license in the state of residence 5+ years clinical practical experience preference: (diabetes, congestive heart failure (CHF), chronic kidney disease (CKD), post-acute care, hospice, palliative care, cardiac) with Medicare members 2+ years case management, discharge planning and/or home health care coordination experience Excellent analytical and problem-solving skills Effective communications, organizational, and interpersonal skills Ability to work independently (may require working from home) Proficiency with standard corporate software applications, including Microsoft Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications Efficient and effective computer skills including navigating multiple systems and keyboarding Preferred Qualifications Candidate must be willing obtain additional state Registered Nurse (RN) licenses if needed, company will provide Bilingual Certified Case Manager National professional certification (CRC, CDMS, CRRN, COHN, or CCM) Education Associate's Degree or Nursing Diploma (REQUIRED) Bachelor’s Degree (PREFERRED) License Active and unrestricted Compact Registered Nurse (RN) license in state of residence Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $60,522.00 - $142,576.00 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: 04/28/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
RN Telehealth Full-time
CVS Health

Case Manager Registered Nurse (Remote, East Coast)

CVS Health CT
$66,575 - $142,576 / year
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Schedule Monday - Friday 8:00 AM - 5:00 PM ET Program Overview Help us elevate our patient care to a whole new level! Join our Community Care team as an industry leader in serving our members by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Community Care members. Community Care is a member centric, team-delivered, community-based care management model that joins members where they are. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country. Family Summary/Mission Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies. Position Summary/Mission Community Care Case Manager use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes. Fundamental Components & Physical Requirements • Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. • Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. • Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services. • Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate. • Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person. • Prepares all required documentation of case work activities as appropriate. • Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes. • May make outreach to treating physician or specialists concerning course of care and treatment as appropriate. • Provides educational and prevention information for best medical outcomes. • Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources. • Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data. • Utilizes case management processes in compliance with regulatory and company policies and procedures. • Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work. • 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/client’s overall wellness through integration. • Monitors member/client progress toward desired outcomes through assessment and evaluation. Required Qualifications • Active and unrestricted Registered Nurse License in East Coast States • Minimum 3+ years clinical practical experience with Medicare members (specifically diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac members) • Minimum 2+ years CM, discharge planning and/or home health care coordination experience • Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications. • Excellent analytical and problem-solving skills • Effective communications, organizational, and interpersonal skills. • Ability to work independently Preferred Qualifications • Bilingual • Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) • Compact RN license or willing and able to obtain multi-state RN licenses if needed Education • Associate's Degree Required, Bachelor's Preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $66,575.00 - $142,576.00 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: 05/01/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
RN Telehealth Full-time
Curana Health

Care Ally, RN Case Manager - PST time zone

Curana Health
Care Ally, RN Case Manager - PST time zone Location US-Remote ID 2026-3377 Category Clinical Support Position Type Full-Time At Curana Health, we’re on a mission to radically improve the health, happiness, and dignity of older adults—and we’re looking for passionate people to help us do it. As a national leader in value-based care, we offer senior living communities and skilled nursing facilities a wide range of solutions (including on-site primary care services, Accountable Care Organizations, and Medicare Advantage Special Needs Plans) proven to enhance health outcomes, streamline operations, and create new financial opportunities. Founded in 2021, we’ve grown quickly—now serving 200,000+ seniors in 1,500+ communities across 32 states. Our team includes more than 1,000 clinicians alongside care coordinators, analysts, operators, and professionals from all backgrounds, all working together to deliver high-quality, proactive solutions for senior living operators and those they care for. If you’re looking to make a meaningful impact on the senior healthcare landscape, you’re in the right place—and we look forward to working with you. For more information about our company, visit CuranaHealth.com. Summary The Care Ally, Case Manager is a key member of the interdisciplinary care team (ICT). They use a collaborative process of assessment, planning, implementing, coordinating, monitoring, and evaluating options and services required to meet the members health and social needs. They act as a liaison between our Members, their Responsible Parties and/or Power of Attorneys (RP/POAs), Advance Plan Provider/PCP, and key Align Senior Care stakeholders. The Care Ally, Case Manager reports to the Supervisor of Case Management. Essential Duties & Responsibilities Responsibilities Executes on strategies and goals set by the Align Senior Care Board of Directors, the Senior Leadership Team, and Executive Director for managing and improving overall Member experience. Contacts Plan members to conduct a comprehensive health assessment of the individual, develop a plan of care, and participate in the facilities interdisciplinary care team meeting. Serves as health coach to educate the member, the family and/or caregiver, about disease status and treatment, plan benefits, community resources, and resource options Collaborates with members of the interdisciplinary care team and medical director(s) to facilitate appropriate treatment for members Routinely follows up with member as scheduled to assess progress towards goals Communicates with the member and/or caregiver to assist with the development of health goals and identify interventions to achieve these goals Provide patient-centered intervention, such as making and verifying appointments, performing medication and care compliance initiatives. Acts as front-line support with Members and their RP/POAs to ensure the needs of the Member are met. Serves as a connection point among Members, their Communities, their Care Team, and Align Senior Care internal departments. Regularly engages Align Senior Care Members and RP/POAs in-person or by phone to provide education and assistance with utilizing Align Senior Care benefits. Including but not limited to. checking on upcoming specialist appointments, connecting members to supplemental benefits and providers, identifying immediate Member needs, and answering any questions the Member or RP/POA may have. Communicates Member health updates from Care Team to RP/POAs. Coordinates with the Care Team for non-urgent health or clinical questions. Works directly with internal departments to solve Member Grievances, Utilization Management, and Billing related issues. Updates Member and RP/POA contact information such as changes of address, email, or phone numbers. Actively supports Account Manager in identifying and securing contracts with "preferred" Providers. Assists Members, RP/POAs, and Partner Communities with locating in-network providers and scheduling/facilitation of appointments. Assists with (on request of member or APP) coordination of home health and therapy visits, ordering of Durable Medical Equipment, and utilization of supplemental benefits for Members. Monitors and, if needed, facilitates care team meetings with facility team, member, responsible partie(s) and the APP/clinical team. Ensures documentation of care team meetings and transmits to Plan. Monitors care plan updates, facilitates APP and PCP input into care plan, and distributes care plan as needed to care team members. Monitors midnight reports/community census to help identify member transitions to hospital or other care levels. Qualifications Education & Experience One (1) year of clinical practice experience in at least one of the following areas: case management, home health, critical care, medical/surgical, discharge planning, concurrent review, or obstetric/neonatal care. Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook, including the ability to navigate multiple systems and keyboarding. Case management certification preferred. Professional Certification Or Licenses Registered nurse license, active and unencumbered state license in the state where job duties are performed is required. BSN preferred OR Active Licensed Social Worker (LSW). Bachelor's degree in social work (BSW) required We’re thrilled to announce that Curana Health has been named the 147 th fastest growing, privately owned company in the nation on Inc. magazine’s prestigious Inc. 5000 list. Curana also ranked 16 th in the “Healthcare & Medical” industry category and 21 st in Texas. This recognition underscores Curana Health’s impact in transforming senior housing by supporting operator stability and ensuring seniors receive the high-quality care they deserve. Options ApplyApply Submit a ReferralRefer Sorry the Share function is not working properly at this moment. Please refresh the page and try again later. Curana Health is dedicated to the principles of Equal Employment Opportunity. We affirm, in policy and practice, our commitment to diversity. We do not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable or state law, genetic information, or any other characteristic protected by applicable federal, state and local laws and ordinances. The EEO policy applies to all personnel matters as outlined in our company policy including recruitment, hiring, transfers, and general treatment during employment. *The company is unable to provide sponsorship for a visa at this time (H1B or otherwise). Application FAQs Software Powered by iCIMS www.icims.com
RN Telehealth Full-time
CVS Health

Case Manager - Registered Nurse

CVS Health GA
$54,095 - $116,760 / year
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Summary The Care Manager—Registered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible for coordinating care for members who often face multiple chronic medical and behavioral health conditions, as well as various social determinants of health (SDoH) needs. This role involves conducting comprehensive assessments to evaluate members’ needs and addressing SDoH challenges by connecting them with appropriate resources and support services. The Social Worker provides education and guidance to members and their families on managing chronic conditions and navigating the healthcare system. Additionally, the Care Manager develops and implements individualized care plans, monitors member progress, advocates for necessary services, and collaborates with the interdisciplinary care team to ensure optimal health outcomes. Accurate and timely documentation of assessments and interventions is essential, as is participation in team meetings to discuss member status and care strategies. Key Responsibilities 50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care. Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member’s identified needs. Provides evidence-based disease management education and support to help the member achieve health goals. Ensure the appropriate members of the interdisciplinary care team are involved in the member’s care. Provides care coordination to support a seamless health care experience for the member. Meticulous documentation of care management activity in the member’s electronic health record. Collaborate with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition. Identifies and connects members with health plan benefits and community resources. Meets regulatory requirements within specified timelines. The Care Manager RN supports other members of the Care Team through clinical decision making and guidance as needed. Additional responsibilities as assigned by leadership to support team objectives, enhance operational efficiency, and ensure the delivery of high-quality care to members. This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members. Essential Competencies and Functions Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements of this role. Conduct oneself with integrity, professionalism, and self-direction. Experience or a willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care. Familiarity with community resources and services. Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records. Maintain strong collaborative and professional relationships with members and colleagues. Communicate effectively, both verbally and in writing. Excellent customer service and engagement skills. Work Expectations Access to a private, dedicated space to conduct work effectively to meet the requirements of the position Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted Required Qualifications Candidate must have active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the Care Manager – Registered Nurse (CM RN) role Access to a private, dedicated space to conduct work effectively to meet the requirements of the position Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually 3+ years of nursing experience 2+ years of case management, discharge planning and/or home healthcare coordination experience Preferred Qualifications Experience providing care management for Medicare and/or Medicaid members Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health Experience conducting health-related assessments and facilitating the care planning process Bilingual skills, especially English-Spanish Education Associate’s of Science in Nursing (ASN) Degree and relevant experience in a health care-related field (REQUIRED) Bachelor’s of Science in Nursing (BSN) (PREFERRED) License Active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $54,095.00 - $116,760.00 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 05/01/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
RN Telehealth Full-time
CVS Health

Case Manager - Registered Nurse

CVS Health GA
$54,095 - $116,760 / year
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Summary The Care Manager—Registered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible for coordinating care for members who often face multiple chronic medical and behavioral health conditions, as well as various social determinants of health (SDoH) needs. This role involves conducting comprehensive assessments to evaluate members’ needs and addressing SDoH challenges by connecting them with appropriate resources and support services. The Social Worker provides education and guidance to members and their families on managing chronic conditions and navigating the healthcare system. Additionally, the Care Manager develops and implements individualized care plans, monitors member progress, advocates for necessary services, and collaborates with the interdisciplinary care team to ensure optimal health outcomes. Accurate and timely documentation of assessments and interventions is essential, as is participation in team meetings to discuss member status and care strategies. Key Responsibilities 50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care. Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member’s identified needs. Provides evidence-based disease management education and support to help the member achieve health goals. Ensure the appropriate members of the interdisciplinary care team are involved in the member’s care. Provides care coordination to support a seamless health care experience for the member. Meticulous documentation of care management activity in the member’s electronic health record. Collaborate with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition. Identifies and connects members with health plan benefits and community resources. Meets regulatory requirements within specified timelines. The Care Manager RN supports other members of the Care Team through clinical decision making and guidance as needed. Additional responsibilities as assigned by leadership to support team objectives, enhance operational efficiency, and ensure the delivery of high-quality care to members. This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members. Essential Competencies and Functions Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements of this role. Conduct oneself with integrity, professionalism, and self-direction. Experience or a willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care. Familiarity with community resources and services. Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records. Maintain strong collaborative and professional relationships with members and colleagues. Communicate effectively, both verbally and in writing. Excellent customer service and engagement skills. Work Expectations Access to a private, dedicated space to conduct work effectively to meet the requirements of the position Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted Required Qualifications Candidate must have active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the Care Manager – Registered Nurse (CM RN) role Access to a private, dedicated space to conduct work effectively to meet the requirements of the position Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually 3+ years of nursing experience 2+ years of case management, discharge planning and/or home healthcare coordination experience Preferred Qualifications Experience providing care management for Medicare and/or Medicaid members Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health Experience conducting health-related assessments and facilitating the care planning process Bilingual skills, especially English-Spanish Education Associate’s of Science in Nursing (ASN) Degree and relevant experience in a health care-related field (REQUIRED) Bachelor’s of Science in Nursing (BSN) (PREFERRED) License Active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $54,095.00 - $116,760.00 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 05/01/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
RN Utilization Review Telehealth Full-time
CVS Health

Utilization Management Nurse Consultant

CVS Health IL
$32.01 - $68.55 / hour
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours. Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. Typical office working environment with productivity and quality expectations. Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment. Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. Effective communication skills, both verbal and written Required Qualifications - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours Preferred Qualifications - 2+ years of clinical experience required in med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in CT zones Education Associates Degree required BSN preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $32.01 - $68.55 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits 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.
RN Manager/Supervisor Telehealth Full-time
CVS Health

Senior Manager, Health Services - Aetna Medical Policy and Program Solutions - Registered Nurse

CVS Health PA
$75,400 - $182,549 / year
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. At Aetna®, part of CVS Health, we proudly serve more than 26 million medical members through our broad range of health plan offerings. We're committed to delivering a simpler, more meaningful, and personal health care experience to each of them. As a key member of the Medical Policy & Program Solutions team, the Senior Manager, Health Services plays a critical role in supporting Aetna members and the business by leading clinical and claims-focused initiatives that drive program effectiveness, regulatory compliance, and cost management across Medicaid and Duals lines of business. This role manages a cross-functional team of health services professionals and coordinates claim editing opportunities, clinical program enhancements, savings initiatives, and vendor implementation efforts. The position is fully remote. Eligible candidates may reside anywhere in the contiguous United States. Required Qualifications 5–7 years of relevant work experience Active, unrestricted Registered Nurse (RN) license in state of residence Certified Professional Coder (AAPC or AHIMA), including Physician, Facility, or Payer certification 1–2 years of project management experience 3–5 years of claims and policy support experience in the healthcare industry; managed care experience preferred Minimum of 3 years of Medicaid and/or Duals experience, including code editing, policy development, and understanding of state guidelines Strong verbal and written communication skills Experience performing root cause analysis and identifying actionable solutions Experience conducting claims analytics to validate industry standards Familiarity with claim editing software and the ability to propose system changes Demonstrated ability to meet project milestones and negotiate for resources High level of proficiency with the Microsoft Office suite, including advanced Excel skills Experience with Lyric ClaimsXten and/or Cotiviti PPM and Coding Validation tools Preferred Qualifications Experience with state Medicaid Regulation/Guidelines Experience with QNXT Claim System Education Registered Nurse required; bachelor’s degree preferred Pay Range The typical pay range for this role is: $75,400.00 - $182,549.00 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. This position also includes an award target in the company’s equity award program. 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/11/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
RN Telehealth Full-time
CVS Health

Case Manager Registered Nurse (Remote, Texas)

CVS Health TX
$60,522 - $129,615 / year
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services. Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate. Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person. Prepares all required documentation of case work activities as appropriate. Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes. May make outreach to treating physician or specialists concerning course of care and treatment as appropriate. Provides educational and prevention information for best medical outcomes. Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources. Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data. Utilizes case management processes in compliance with regulatory and company policies and procedures. Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work. 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/client’s overall wellness through integration. Monitors member/client progress toward desired outcomes through assessment and evaluation. Required Qualifications Active and unrestricted compact RN licensure Minimum 3+ years clinical practical experience with preference in the following areas: diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac, home health with Medicare members. Minimum 2+ years case management, discharge planning and/or home health care coordination experience Preferred Qualifications Bilingual Spanish is preferred Excellent analytical and problem-solving skills Effective communications, organizational, and interpersonal skills. Ability to work independently. Certified Case Manager is preferred. Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) Efficient and Effective computer skills including navigating multiple systems and keyboarding Willing and able to obtain multi state RN licenses if needed, company will provide - preference for candidates that already have MI and IL single state license in addition to compact license Preference for candidates that reside in Texas Education Associates or Nursing Diploma required Bachelors preferred Anticipated Weekly Hours 40 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/16/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
RN Utilization Review Telehealth Full-time
CVS Health

Utilization Management Nurse Consultant

CVS Health OH
$29.10 - $62.32 / hour
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours. Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. Typical office working environment with productivity and quality expectations. Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment. Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. Effective communication skills, both verbal and written Required Qualifications - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours Preferred Qualifications - 2+ years of clinical experience required in med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Prefe rence for those residing in Eastern Standard Time (EST) zone. Education Associates Degree required BSN preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $29.10 - $62.32 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/18/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
RN Telehealth Full-time
CVS Health

Case Manager - Registered Nurse

CVS Health MS
$54,095 - $116,760 / year
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Summary The Care Manager—Registered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible for coordinating care for members who often face multiple chronic medical and behavioral health conditions, as well as various social determinants of health (SDoH) needs. This role involves conducting comprehensive assessments to evaluate members’ needs and addressing SDoH challenges by connecting them with appropriate resources and support services. The Social Worker provides education and guidance to members and their families on managing chronic conditions and navigating the healthcare system. Additionally, the Care Manager develops and implements individualized care plans, monitors member progress, advocates for necessary services, and collaborates with the interdisciplinary care team to ensure optimal health outcomes. Accurate and timely documentation of assessments and interventions is essential, as is participation in team meetings to discuss member status and care strategies. Key Responsibilities 50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care. Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member’s identified needs. Provides evidence-based disease management education and support to help the member achieve health goals. Ensure the appropriate members of the interdisciplinary care team are involved in the member’s care. Provides care coordination to support a seamless health care experience for the member. Meticulous documentation of care management activity in the member’s electronic health record. Collaborate with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition. Identifies and connects members with health plan benefits and community resources. Meets regulatory requirements within specified timelines. The Care Manager RN supports other members of the Care Team through clinical decision making and guidance as needed. Additional responsibilities as assigned by leadership to support team objectives, enhance operational efficiency, and ensure the delivery of high-quality care to members. This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members. Essential Competencies and Functions Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements of this role. Conduct oneself with integrity, professionalism, and self-direction. Experience or a willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care. Familiarity with community resources and services. Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records. Maintain strong collaborative and professional relationships with members and colleagues. Communicate effectively, both verbally and in writing. Excellent customer service and engagement skills. Work Expectations Access to a private, dedicated space to conduct work effectively to meet the requirements of the position Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted Required Qualifications Candidate must have active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the Care Manager – Registered Nurse (CM RN) role Access to a private, dedicated space to conduct work effectively to meet the requirements of the position Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually 3+ years of nursing experience 2+ years of case management, discharge planning and/or home healthcare coordination experience Preferred Qualifications Experience providing care management for Medicare and/or Medicaid members Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health Experience conducting health-related assessments and facilitating the care planning process Bilingual skills, especially English-Spanish Education Associate’s of Science in Nursing (ASN) Degree and relevant experience in a health care-related field (REQUIRED) Bachelor’s of Science in Nursing (BSN) (PREFERRED) License Active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $54,095.00 - $116,760.00 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/05/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
RN Utilization Review Telehealth Full-time
CVS Health

Utilization Management Nurse Consultant

CVS Health PA
$29.10 - $62.32 / hour
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization management is a 24/7 operation. Work schedules may include weekends and holidays and evening rotations. Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. Typical office working environment with productivity and quality expectations. Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment. Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. Effective communication skills, both verbal and written Required Qualifications Must have active current and unrestricted RN licensure in state of residence 3+ years of experience as a Registered Nurse 1+ years of clinical experience in acute or post-acute setting Candidates must be able to work Monday - Friday 8:00am-5:00pm EST with late night rotation 10:30 - 7pm EST. Work schedules include weekends, holidays and evening rotations Preferred Qualifications Experience working in ER, Med/Surg, and/or Critical care setting Managed Care experience Utilization review experience Experience working with MS office applications such as Teams, Outlook, Excel, and Word Education Minimum of an Associate's Degree in Nursing BSN preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $29.10 - $62.32 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/18/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
RN Telehealth Full-time
CVS Health

Care Manager – Registered Nurse

CVS Health TX
$60,522 - $129,615 / year
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Summary The Care Manager—Registered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible for coordinating care for members who often face multiple chronic medical and behavioral health conditions, as well as various social determinants of health (SDoH) needs. This role involves conducting comprehensive assessments to evaluate members’ needs and addressing SDoH challenges by connecting them with appropriate resources and support services. The Social Worker provides education and guidance to members and their families on managing chronic conditions and navigating the healthcare system. Additionally, the Care Manager develops and implements individualized care plans, monitors member progress, advocates for necessary services, and collaborates with the interdisciplinary care team to ensure optimal health outcomes. Accurate and timely documentation of assessments and interventions is essential, as is participation in team meetings to discuss member status and care strategies. Key Responsibilities 50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care. Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member’s identified needs. Provides evidence-based disease management education and support to help the member achieve health goals. Ensure the appropriate members of the interdisciplinary care team are involved in the member’s care. Provides care coordination to support a seamless health care experience for the member. Meticulous documentation of care management activity in the member’s electronic health record. Collaborate with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition. Identifies and connects members with health plan benefits and community resources. Meets regulatory requirements within specified timelines. The Care Manager RN supports other members of the Care Team through clinical decision making and guidance as needed. Additional responsibilities as assigned by leadership to support team objectives, enhance operational efficiency, and ensure the delivery of high-quality care to members. This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members. Essential Competencies and Functions Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements of this role. Conduct oneself with integrity, professionalism, and self-direction. Experience or a willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care. Familiarity with community resources and services. Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records. Maintain strong collaborative and professional relationships with members and colleagues. Communicate effectively, both verbally and in writing. Excellent customer service and engagement skills. Work Expectations Access to a private, dedicated space to conduct work effectively to meet the requirements of the position Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted Required Qualifications Candidate must have active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the Care Manager – Registered Nurse (CM RN) role Access to a private, dedicated space to conduct work effectively to meet the requirements of the position Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually 3+ years of nursing experience 2+ years of case management, discharge planning and/or home healthcare coordination experience Preferred Qualifications Experience providing care management for Medicare and/or Medicaid members Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health Experience conducting health-related assessments and facilitating the care planning process Bilingual skills, especially English-Spanish Education Associate’s of Science in Nursing (ASN) Degree and relevant experience in a health care-related field (REQUIRED) Bachelor’s of Science in Nursing (BSN) (PREFERRED) License Active and unrestricted Compact Registered Nurse (RN) licensure in the state of residence Anticipated Weekly Hours 40 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 05/01/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
RN Telehealth Full-time
CVS Health

Case Manager, Registered Nurse

CVS Health PA
$60,522 - $129,615 / month
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Summary The Care Manager—Registered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible for coordinating care for members who often face multiple chronic medical and behavioral health conditions, as well as various social determinants of health (SDoH) needs. This role involves conducting comprehensive assessments to evaluate members’ needs and addressing SDoH challenges by connecting them with appropriate resources and support services. The Social Worker provides education and guidance to members and their families on managing chronic conditions and navigating the healthcare system. Additionally, the Care Manager develops and implements individualized care plans, monitors member progress, advocates for necessary services, and collaborates with the interdisciplinary care team to ensure optimal health outcomes. Accurate and timely documentation of assessments and interventions is essential, as is participation in team meetings to discuss member status and care strategies. Key Responsibilities 50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care. Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member’s identified needs. Provides evidence-based disease management education and support to help the member achieve health goals. Ensure the appropriate members of the interdisciplinary care team are involved in the member’s care. Provides care coordination to support a seamless health care experience for the member. Meticulous documentation of care management activity in the member’s electronic health record. Collaborate with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition. Identifies and connects members with health plan benefits and community resources. Meets regulatory requirements within specified timelines. The Care Manager RN supports other members of the Care Team through clinical decision making and guidance as needed. Additional responsibilities as assigned by leadership to support team objectives, enhance operational efficiency, and ensure the delivery of high-quality care to members. This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members. Essential Competencies and Functions Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements of this role. Conduct oneself with integrity, professionalism, and self-direction. Experience or a willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care. Familiarity with community resources and services. Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records. Maintain strong collaborative and professional relationships with members and colleagues. Communicate effectively, both verbally and in writing. Excellent customer service and engagement skills. Required Qualifications Candidate must have active and unrestricted Registered Nurse (RN) licensure in the state of Pennsylvania (PA) OR Compact Registered Nurse (RN) licensure in state of residence Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the Care Manager Registered Nurse (RN) role Access to a private, dedicated space to conduct work effectively to meet the requirements of the position Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually 3+ years of nursing experience 2+ years of case management, discharge planning and/or home healthcare coordination experience Preferred Qualifications Experience providing care management for Medicare and/or Medicaid members Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health Experience conducting health-related assessments and facilitating the care planning process Bilingual skills, especially English-Spanish Education Associate’s of Science in Nursing (ASN) degree AND relevant experience in a health care-related field (REQUIRED) Bachelor’s of Science in Nursing (BSN) (PREFERRED) License Active and unrestricted Registered Nurse (RN) licensure in the state of Pennsylvania (PA) OR Compact Registered Nurse licensure in state of residence Anticipated Weekly Hours 40 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/22/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
RN Telehealth Full-time
CVS Health

Case Manager - Registered Nurse

CVS Health PA
$60,522 - $129,615 / year
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Job Summary The Care Manager—Registered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible for coordinating care for members who often face multiple chronic medical and behavioral health conditions, as well as various social determinants of health (SDoH) needs. This role involves conducting comprehensive assessments to evaluate members’ needs and addressing SDoH challenges by connecting them with appropriate resources and support services. The Social Worker provides education and guidance to members and their families on managing chronic conditions and navigating the healthcare system. Additionally, the Care Manager develops and implements individualized care plans, monitors member progress, advocates for necessary services, and collaborates with the interdisciplinary care team to ensure optimal health outcomes. Accurate and timely documentation of assessments and interventions is essential, as is participation in team meetings to discuss member status and care strategies. Key Responsibilities 50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care. Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member’s identified needs. Provides evidence-based disease management education and support to help the member achieve health goals. Ensure the appropriate members of the interdisciplinary care team are involved in the member’s care. Provides care coordination to support a seamless health care experience for the member. Meticulous documentation of care management activity in the member’s electronic health record. Collaborate with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition. Identifies and connects members with health plan benefits and community resources. Meets regulatory requirements within specified timelines. The Care Manager RN supports other members of the Care Team through clinical decision making and guidance as needed. Additional responsibilities as assigned by leadership to support team objectives, enhance operational efficiency, and ensure the delivery of high-quality care to members. This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members. Essential Competencies and Functions Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements of this role. Conduct oneself with integrity, professionalism, and self-direction. Experience or a willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care. Familiarity with community resources and services. Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records. Maintain strong collaborative and professional relationships with members and colleagues. Communicate effectively, both verbally and in writing. Excellent customer service and engagement skills. Required Qualifications Candidate must have active and unrestricted Registered Nurse (RN) licensure in the state of Pennsylvania (PA) OR Compact Registered Nurse (RN) licensure in state of residence Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the Care Manager Registered Nurse (RN) role Access to a private, dedicated space to conduct work effectively to meet the requirements of the position Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually 3+ years of nursing experience 2+ years of case management, discharge planning and/or home healthcare coordination experience Preferred Qualifications Experience providing care management for Medicare and/or Medicaid members Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health Experience conducting health-related assessments and facilitating the care planning process Bilingual skills, especially English-Spanish Education Associate’s of Science in Nursing (ASN) degree AND relevant experience in a health care-related field (REQUIRED) Bachelor’s of Science in Nursing (BSN) (PREFERRED) License Active and unrestricted Registered Nurse (RN) licensure in the state of Pennsylvania (PA) OR Compact Registered Nurse licensure in state of residence Anticipated Weekly Hours 40 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/22/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
RN Utilization Review Telehealth Full-time
CVS Health

Utilization Management Nurse Consultant

CVS Health IA
$26.01 - $56.14 / hour
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours. Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. Typical office working environment with productivity and quality expectations. Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment. Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. Effective communication skills, both verbal and written Required Qualifications - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours Preferred Qualifications - 2+ years of clinical experience required in med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in CST zones Education Associates Degree required BSN preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $26.01 - $56.14 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits 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.
RN Utilization Review Telehealth Full-time
CVS Health

Utilization Management Nurse Consultant

CVS Health OH
$29.10 - $62.32 / hour
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours. Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. Typical office working environment with productivity and quality expectations. Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment. Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. Effective communication skills, both verbal and written Required Qualifications - 2+ years of experience as a Registered Nurse in adult acute care/critical care setting - Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours Preferred Qualifications - 2+ years of clinical experience required in med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in EST zones Education Associates Degree required BSN preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $29.10 - $62.32 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits 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.
RN Utilization Review Telehealth Full-time
CVS Health

Utilization Management Nurse Consultant - Open to residents in Pacific Standard Time Zone

CVS Health NV
$29.10 - $62.32 / hour
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Must Reside in PST Time Zone Position Summary Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours. This is a full-time, remote role. Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs. Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization. Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. Typical office working environment with productivity and quality expectations. Work requires the ability to perform close inspection of handwritten and computer generated documents as well as a PC monitor. Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment. Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. Effective communication skills, both verbal and written. Required Qualifications Must reside in Pacific Standard Time Zone 2+ years of experience as a Registered Nurse in adult acute care/critical care setting. Must have active current and unrestricted RN licensure in state of residence. Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours. Preferred Qualifications 2+ years of clinical experience required in med surg or specialty area. Managed Care experience preferred, especially Utilization Management. Preference for those residing in PST zones. Education Associates Degree required BSN preferred Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $29.10 - $62.32 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits 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.
RN Utilization Review Telehealth Full-time
CVS Health

Utilization Management Nurse Consultant - Fully Remote

CVS Health
$26.01 - $74.78 / hour
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary CVS Health Aetna has an opportunity for a full-time Utilization Management (UM) Nurse Consultant. As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times. This includes reviewing written clinical records. Key Responsibilities of the UM Nurse Consultant (Includes but is not limited to) Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning and works closely with facilities and providers to meet the complex needs of the member. Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation along the continuum of care. Communicates with providers and other parties to facilitate care/treatment. Identifies members for referral opportunities to integrate with other products, services and/or programs. Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization. Required Qualifications Registered Nurse (RN) with current unrestricted US licensure in their state of residence is required. 2+ years clinical practice experience as an RN required. 2+ Years Utilization Management experience. Must be willing to travel to the local office as needed if living within approximately 45 minutes/miles. Preferred Qualifications Bilingual proficiency preferred. 1+ year(s) experience utilizing multiple computer systems and applications including Microsoft Word, Excel, Outlook, and web-based applications. Education Associate’s degree in Nursing required. BSN preferred. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $26.01 - $74.78 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/03/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
RN Telehealth Full-time
CVS Health

Case Manager, Registered Nurse (NJ, PA, WV)

CVS Health PA
$60,522 - $129,615 / year
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary This is a full-time telework position. The hours for this position are Monday-Friday 8:00a-5:00p EST. Program Overview Help us elevate our patient care to a whole new level! Join our Community Care team as an industry leader in serving our members by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Community Care members. Community Care is a member centric, team-delivered, community-based care management model that joins members where they are. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country. Family Summary/Mission Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements, and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies. Position Summary/Mission Community Care Case Manager use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes. Fundamental Components & Physical Requirements Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. Interacts with members/clients telephonically Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate. Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person. Prepares all required documentation of case work activities as appropriate. Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes. May make outreach to treating physician or specialists concerning course of care and treatment as appropriate. Provides educational and prevention information for best medical outcomes. Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources. Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data. Utilizes case management processes in compliance with regulatory and company policies and procedures. Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work. 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/client’s overall wellness through integration. Monitors member/client progress toward desired outcomes through assessment and evaluation. Required Qualifications 3+ years clinical practical experience preference: (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members. Ability to occasionally travel within a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs arise. Reliable transportation required. Mileage is reimbursed per our company expense reimbursement policy 1+ year(s) of experience with Microsoft Office applications (MS Word, Excel, Outlook and PowerPoint) Must have active and unrestricted Registered Nurse license in NJ, PA or WV Preferred Qualifications Active Compact Registered Nurse License in NJ, PA or WV Minimum 2+ years CM, discharge planning and/or home health care coordination experience Certified Case Manager is preferred. Excellent analytical and problem-solving skills Effective communications, organizational, and interpersonal skills. Efficient and Effective computer skills including navigating multiple systems and keyboarding Education Associates degree required Bachelors degree preferred Anticipated Weekly Hours 40 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan . No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 04/01/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.