Case Manager Registered Nurse (Remote, Illinois)

About the role

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.

Program Overview

Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges.

What You Will Do

• Administers the care coordination plan to assess patient needs and ensure seamless transitions between different care settings.
• Analyzes complex patient data from medical history, diagnostic test results, and treatment plans, to understand the current health status of the patient.
• Applies in-depth knowledge of case management to organize patient files in an orderly manner for easy retrieval.
• Communicates through internal platforms to securely exchange messages, conduct video conferences, share files, and collaborate on patient care plans.
• Conducts routine utilization reviews to ensure patients have access to appropriate cost-effective care.
• Coordinates analytics projects to enable case managers to analyze data and generate reports on key performance health indicators.
• Designs complex processes to coordinate discharge planning in a safe and timely transition from the hospital to home.
• Develops resource management to help case managers optimize healthcare with community resources.

Required Qualifications

• This position will typically be a Work from Home role however candidate's must possess reliable transportation and be willing and able to travel up to 30% of the time if needed, in and around candidate's home location.
• Mileage is reimbursed per our company expense reimbursement policy
• 3-5 years of direct clinical practice experience e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
• Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually
• Effective communications, organizational, and interpersonal skills
• Ability to work independently
• Proficiency with standard corporate software applications, including MS 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

• Case management and discharge planning experience
• Managed care/utilization review experience
• Crisis intervention skills
• Certified Case Manager
• Bilingual

Education And Certification Requirements

• Associate's Required, Bachelor's preferred
• Active and Unencumbered Registered Nurse License in Illinois

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.

Additional Information

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.