Care Manager

Overview At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose‑driven colleagues—caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Position Summary Case Manager RN is a 100% remote position; the employee can live in any state. Normal working hours: Monday‑Friday 8:00 am – 4:30 pm in the employee’s residence time zone. Occasional late‑shift rotations 10:30 am – 7 pm EST (1–2 times per quarter). Typical training hours: Monday‑Friday 8:00 am – 4:30 pm EST. Responsibilities Develop a proactive course of action to address issues presented to enhance short- and long-term outcomes and opportunities to enhance a member’s overall wellness through integration. Services strategies, policies, and programs are comprised of network management and clinical coverage policies. Through the use of clinical tools and information/data review, conduct an evaluation of member’s needs and benefit plan eligibility and facilitate integrative functions as well as smooth transition to Aetna programs and plans. Apply clinical judgment to incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators impacting care planning and resolution of member issues. Assessments take into account information from various sources to address all conditions including co‑morbidity and multiple diagnoses impacting functionality. Review 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. Consult with supervisor and others to overcome barriers in meeting goals and objectives; present cases at case conferences for multidisciplinary focus to benefit overall claim management. Utilize case‑management processes in compliance with regulatory and company policies and procedures. Utilize MI skills to ensure maximum member engagement and discern their health status. Required Qualifications Active, current, and unrestricted RN license in state of residence; willingness and ability to obtain additional state licenses upon hire (paid by company). 5+ years of acute‑care experience as an RN. Willing and able to work Monday‑Friday 8:00 am – 4:30 pm in the employee’s residence time zone; occasional late‑shift rotations 10:30 am – 7 pm EST. Strong computer skills. Microsoft 365 Suite familiarity. Preferred Qualifications Compact state licensure. CCM certification. Experience in case‑management. Home‑care experience. Spanish speaking/bilingual. Oncology experience/background. Education Associate’s degree with RN licensure required; BSN preferred. Hours & Compensation Anticipated weekly hours: 40. Pay range: $60,522.00 – $129,615.00 (base hourly rate or base annual full‑time salary; actual offer depends on experience, education, geography and other factors). Eligible for bonus, commission, or short‑term incentive program. Benefits Affordable medical plan options, 401(k) plan with company matching, employee stock purchase plan. No‑cost wellness programs: screenings, tobacco cessation, weight management, confidential counseling, financial coaching. Benefit solutions addressing different colleague needs: paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and more. Application Deadline 12/17/2025 EEO Statement Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Seniority Level Mid‑Senior level Employment Type Full‑time Job Function Health Care Provider Industries Hospitals and Health Care #J-18808-Ljbffr