Registered Nurse Manager jobs at CVS Health

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 SummaryCVS Health Aetna has an opportunity for a full-time Case Manager, Registered Nurse (RN). Case Managers serve as dedicated advocates for members who are unable to advocate for themselves. In this role, you will assess, plan, implement, and coordinate comprehensive case management activities. Your focus will be to evaluate members' medical needs and facilitate services that support their overall health and well-being. Schedule: Monday-Friday, 8:00 AM-5:00 PM ESTNo nights, weekends, or holidays required. Key Responsibilities of the Case Manager RN (Includes but is not limited to) Conduct comprehensive assessments of members' physical, emotional, and social needs. Develop and implement individualized care plans based on clinical findings and member goals. Coordinate services across healthcare providers, specialists, and community resources. Monitor and evaluate care plans regularly, adjusting as needed to improve outcomes. Advocate for timely and appropriate healthcare services to support member well-being. Document case activities, interventions, and communications accurately and in compliance with regulatory requirements. Collaborate with interdisciplinary teams to ensure continuity of care. Participate in team meetings, training sessions, and quality improvement initiatives. Travel locally for in-person case management activities, as directed by leadership or business needs. Required QualificationsMust be a Registered Nurse with an active state license in good standing, valid in the region where duties are performed. Compact RN License or license in multiple states or willing to obtain within 3-6 months. Bilingual proficiency in Spanish. 3-5 years of clinical practice experience. 2-3 years of experience in case management, discharge planning, or home health care coordination. Comfortable working remotely and independently using collaboration tools and virtual communication platforms. Willingness and ability to travel within a designated geographic area for in-person case management activities as needed. Preferred QualificationsStrong analytical and problem-solving skills. Excellent communication, organizational, and interpersonal skills. Self-motivated and able to work independently. Proficient in navigating multiple systems and applications; skilled in typing and keyboard use. Familiarity with corporate software tools such as Microsoft Word, Excel, Outlook, PowerPoint, and proprietary applications. EducationAssociate's Degree in Nursing. BSN preferred. Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$54,095. 00 - $155,538. 00This 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 ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on: 01/09/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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** **This is a remote work from home role anywhere in the US with virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members. **Key Responsibilities** + This position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits. + 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 utilize information from various sources to address all conditions including co-morbid and multiple diagnoses that impact 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. + Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives. + Utilizes case management processes in compliance with regulatory and company policies and procedures. + Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversations. + Identifies and escalates member's needs appropriately following set guidelines and protocols. + Need to actively reach out to members to collaborate/guide their care. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital setting. + A Registered Nurse that holds an active, unrestricted license in their state of residence, and willingness to receive a multi-state/compact privileges and can be licensed in all non-compact states. + 1+ years' experience documenting electronically using a keyboard. + 1+ years' current or previous experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/Substance Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience as well as experience with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review. + CCM and/or other URAC recognized accreditation preferred. + 1+ years' experience with MCG, NCCN and/or Lexicomp. + Bilingual in Spanish preferred. **Education** + Diploma or Associates Degree in Nursing required. + BSN preferred. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $54,095.00 - $155,538.00 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. 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 ***************************************** This job does not have an application deadline, as CVS Health accepts applications on an ongoing basis. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

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. Drives effective utilization management practices by ensuring appropriate and cost-effective allocation of healthcare resources and facilitating appropriate healthcare services/benefits for members. Conducts routine utilization reviews and assessments, applying evidence-based criteria and clinical knowledge to evaluate the medical necessity and appropriateness of requested healthcare services. Collaborates with healthcare providers, multidisciplinary teams, and payers to develop and implement care plans that optimize patient outcomes while considering the efficient use of healthcare resources. Applies clinical expertise and knowledge of utilization management principles to influence stakeholders and networks of healthcare professionals by promoting effective utilization management strategies. Reviews and analyzes medical records, treatment plans, and documentation to ensure compliance with guidelines, policies, and regulatory requirements, subsequently providing recommendations for care coordination and resource optimization. Consults with and provides expertise to other internal and external constituents throughout the coordination and administration of the utilization/benefit management function. Communicates regularly with internal and external stakeholders to facilitate effective care coordination, address utilization management inquiries, and ensure optimal patient outcomes. Provides IC-related coaching and guidance to nursing staff and other healthcare professionals, sharing knowledge and expertise to enhance their understanding of utilization management principles and improve their clinical decision-making. Contributes to the development and implementation of utilization management strategies, policies, and procedures that aim to improve patient care quality, cost-effectiveness, and overall healthcare system performance. **Education** Bachelor's degree preferred/specialized training/relevant professional qualification. Registered Nurse (RN) required. **Prior Relevant Work Experience** 3-5 years Essential Qualifications Working knowledge of problem solving and decision making skills. Working knowledge of medical terminology. Working knowledge of digital literacy skills. Ability to deal tactfully with customers and community. Ability to handle sensitive information ethically and responsibly. Ability to consider the relative costs and benefits of potential actions to choose the most appropriate option. Ability to function in clinical setting with diverse cultural dynamics of clinical staff and patients. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $26.01 - $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 ***************************************** We anticipate the application window for this opening will close on: 12/31/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

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** CVS Aetna is seeking a dedicated **Appeals Nurse Consultant** to join our remote team. In this role, you will be responsible for processing the medical necessity of Medicare appeals for participating providers. **Key Responsibilities** + Requesting clinical, research, extrapolating pertinent clinical, applying appropriate Medicare Guidelines, navigate through multiple computer system applications in a fast-paced department. + Must work independently as well as in a team environment while working remotely. + Fast paced sedentary position, talking on the telephone, looking at computer screens, utilizing templates in Word, and typing on the computer. + Responsible for the review and resolution of clinical appeals. + Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for provider issues. + This is a full-time telework position with standard hours of Monday-Friday, 8:00 AM to 5:00 PM (local time). + No weekends or holidays required. **Remote Work Expectations** + This is a 100% remote role; candidates must have a dedicated workspace free of interruptions. + Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted. **Required Qualifications** + Must have active and unrestricted RN licensure in state of residence. + 3+ years clinical experience. **Preferred Qualifications** + Appeals, Managed Care, or Utilization Review experience. + Pre Certification or Pre Authorization experience + Proficiency with computer skills including navigating multiple systems. + Exceptional communication skills. + Time efficient, highly organized, and ability to multitask. **Education** + Associates Degree minimum OR Diploma RN 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 ***************************************** We anticipate the application window for this opening will close on: 01/19/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

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** **This is a remote work from home role anywhere in the US with virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members. **Key Responsibilities** + This position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits. + 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 utilize information from various sources to address all conditions including co-morbid and multiple diagnoses that impact 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. + Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives. + Utilizes case management processes in compliance with regulatory and company policies and procedures. + Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversations. + Identifies and escalates member's needs appropriately following set guidelines and protocols. + Need to actively reach out to members to collaborate/guide their care. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital setting. + A Registered Nurse that holds an active, unrestricted license in their state of residence, and willingness to receive a multi-state/compact privileges and can be licensed in all non-compact states. + 1+ years' experience documenting electronically using a keyboard. + 1+ years' current or previous experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/Substance Abuse or Maternity/ Obstetrics experience. **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience as well as experience with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review. + CCM and/or other URAC recognized accreditation preferred. + 1+ years' experience with MCG, NCCN and/or Lexicomp. + Bilingual in Spanish preferred. **Education** + Diploma or Associates Degree in Nursing required. + BSN preferred. **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $54,095.00 - $155,538.00 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. 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 ***************************************** This job does not have an application deadline, as CVS Health accepts applications on an ongoing basis. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

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 This is a remote work from home role anywhere in the US with virtual training. American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members. Key ResponsibilitiesThis position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients. Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits. 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 utilize information from various sources to address all conditions including co-morbid and multiple diagnoses that impact 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. Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversations. Identifies and escalates member's needs appropriately following set guidelines and protocols. Need to actively reach out to members to collaborate/guide their care. Perform medical necessity reviews. Required Qualifications5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital setting. A Registered Nurse that holds an active, unrestricted license in their state of residence, and willingness to receive a multi-state/compact privileges and can be licensed in all non-compact states. 1+ years' experience documenting electronically using a keyboard. 1+ years' current or previous experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/Substance Abuse or Maternity/ Obstetrics experience. Preferred Qualifications1+ years' Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience as well as experience with transferring patients to lower levels of care. 1+ years' experience in Utilization Review. CCM and/or other URAC recognized accreditation preferred. 1+ years' experience with MCG, NCCN and/or Lexicomp. Bilingual in Spanish preferred. EducationDiploma or Associates Degree in Nursing required. BSN preferred. Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$54,095. 00 - $155,538. 00This 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. 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 ************* cvshealth. com/us/en/benefits This job does not have an application deadline, as CVS Health accepts applications on an ongoing basis. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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. **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 Care Manager 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 Ohio OR compact 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 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 + 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** + Must have active and unrestricted Registered Nurse (RN) licensure in the state of Ohio + State-specific license required prior to start date (internal candidates) **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 ***************************************** We anticipate the application window for this opening will close on: 01/02/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

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 SummaryCVS Health Aetna has an opportunity for a full-time Case Manager, Registered Nurse (RN). Case Managers serve as dedicated advocates for members who are unable to advocate for themselves. In this role, you will assess, plan, implement, and coordinate comprehensive case management activities. Your focus will be to evaluate members' medical needs and facilitate services that support their overall health and well-being. Schedule: Monday-Friday, 8:00 AM-5:00 PM ESTNo nights, weekends, or holidays required. Key Responsibilities of the Case Manager RN (Includes but is not limited to) Conduct comprehensive assessments of members' physical, emotional, and social needs. Develop and implement individualized care plans based on clinical findings and member goals. Coordinate services across healthcare providers, specialists, and community resources. Monitor and evaluate care plans regularly, adjusting as needed to improve outcomes. Advocate for timely and appropriate healthcare services to support member well-being. Document case activities, interventions, and communications accurately and in compliance with regulatory requirements. Collaborate with interdisciplinary teams to ensure continuity of care. Participate in team meetings, training sessions, and quality improvement initiatives. Travel locally for in-person case management activities, as directed by leadership or business needs. Required QualificationsMust be a Registered Nurse with an active state license in good standing, valid in the region where duties are performed. Compact RN License or license in multiple states or willing to obtain within 3-6 months. Bilingual proficiency in Spanish. 3-5 years of clinical practice experience. 2-3 years of experience in case management, discharge planning, or home health care coordination. Comfortable working remotely and independently using collaboration tools and virtual communication platforms. Willingness and ability to travel within a designated geographic area for in-person case management activities as needed. Preferred QualificationsStrong analytical and problem-solving skills. Excellent communication, organizational, and interpersonal skills. Self-motivated and able to work independently. Proficient in navigating multiple systems and applications; skilled in typing and keyboard use. Familiarity with corporate software tools such as Microsoft Word, Excel, Outlook, PowerPoint, and proprietary applications. EducationAssociate's Degree in Nursing. BSN preferred. Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$54,095. 00 - $155,538. 00This 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 ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on: 01/09/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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 SummaryCVS Health Aetna has an opportunity for a full-time Case Manager, Registered Nurse (RN). Case Managers serve as dedicated advocates for members who are unable to advocate for themselves. In this role, you will assess, plan, implement, and coordinate comprehensive case management activities. Your focus will be to evaluate members' medical needs and facilitate services that support their overall health and well-being. Schedule: Monday-Friday, 8:00 AM-5:00 PM ESTNo nights, weekends, or holidays required. Key Responsibilities of the Case Manager RN (Includes but is not limited to) Conduct comprehensive assessments of members' physical, emotional, and social needs. Develop and implement individualized care plans based on clinical findings and member goals. Coordinate services across healthcare providers, specialists, and community resources. Monitor and evaluate care plans regularly, adjusting as needed to improve outcomes. Advocate for timely and appropriate healthcare services to support member well-being. Document case activities, interventions, and communications accurately and in compliance with regulatory requirements. Collaborate with interdisciplinary teams to ensure continuity of care. Participate in team meetings, training sessions, and quality improvement initiatives. Travel locally for in-person case management activities, as directed by leadership or business needs. Required QualificationsMust be a Registered Nurse with an active state license in good standing, valid in the region where duties are performed. Compact RN License or license in multiple states or willing to obtain within 3-6 months. Bilingual proficiency in Spanish. 3-5 years of clinical practice experience. 2-3 years of experience in case management, discharge planning, or home health care coordination. Comfortable working remotely and independently using collaboration tools and virtual communication platforms. Willingness and ability to travel within a designated geographic area for in-person case management activities as needed. Preferred QualificationsStrong analytical and problem-solving skills. Excellent communication, organizational, and interpersonal skills. Self-motivated and able to work independently. Proficient in navigating multiple systems and applications; skilled in typing and keyboard use. Familiarity with corporate software tools such as Microsoft Word, Excel, Outlook, PowerPoint, and proprietary applications. EducationAssociate's Degree in Nursing. BSN preferred. Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$54,095. 00 - $155,538. 00This 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 ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on: 01/09/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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 SummaryCVS Health Aetna has an opportunity for a full-time Case Manager, Registered Nurse (RN). Case Managers serve as dedicated advocates for members who are unable to advocate for themselves. In this role, you will assess, plan, implement, and coordinate comprehensive case management activities. Your focus will be to evaluate members' medical needs and facilitate services that support their overall health and well-being. Schedule: Monday-Friday, 8:00 AM-5:00 PM ESTNo nights, weekends, or holidays required. Key Responsibilities of the Case Manager RN (Includes but is not limited to) Conduct comprehensive assessments of members' physical, emotional, and social needs. Develop and implement individualized care plans based on clinical findings and member goals. Coordinate services across healthcare providers, specialists, and community resources. Monitor and evaluate care plans regularly, adjusting as needed to improve outcomes. Advocate for timely and appropriate healthcare services to support member well-being. Document case activities, interventions, and communications accurately and in compliance with regulatory requirements. Collaborate with interdisciplinary teams to ensure continuity of care. Participate in team meetings, training sessions, and quality improvement initiatives. Travel locally for in-person case management activities, as directed by leadership or business needs. Required QualificationsMust be a Registered Nurse with an active state license in good standing, valid in the region where duties are performed. Compact RN License or license in multiple states or willing to obtain within 3-6 months. Bilingual proficiency in Spanish. 3-5 years of clinical practice experience. 2-3 years of experience in case management, discharge planning, or home health care coordination. Comfortable working remotely and independently using collaboration tools and virtual communication platforms. Willingness and ability to travel within a designated geographic area for in-person case management activities as needed. Preferred QualificationsStrong analytical and problem-solving skills. Excellent communication, organizational, and interpersonal skills. Self-motivated and able to work independently. Proficient in navigating multiple systems and applications; skilled in typing and keyboard use. Familiarity with corporate software tools such as Microsoft Word, Excel, Outlook, PowerPoint, and proprietary applications. EducationAssociate's Degree in Nursing. BSN preferred. Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$54,095. 00 - $155,538. 00This 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 ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on: 01/09/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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 SummaryCVS Aetna is seeking a dedicated Appeals Nurse Consultant to join our remote team. In this role, you will be responsible for processing the medical necessity of Medicare appeals for participating providers. Key ResponsibilitiesRequesting clinical, research, extrapolating pertinent clinical, applying appropriate Medicare Guidelines, navigate through multiple computer system applications in a fast-paced department. Must work independently as well as in a team environment while working remotely. Fast paced sedentary position, talking on the telephone, looking at computer screens, utilizing templates in Word, and typing on the computer. Responsible for the review and resolution of clinical appeals. Reviews documentation and interprets data obtained from clinical records to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for provider issues. This is a full-time telework position with standard hours of Monday-Friday, 8:00 AM to 5:00 PM (local time). No weekends or holidays required. Remote Work ExpectationsThis is a 100% remote role; candidates must have a dedicated workspace free of interruptions. Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted. Required QualificationsMust have active and unrestricted RN licensure in state of residence. 3+ years clinical experience. Preferred QualificationsAppeals, Managed Care, or Utilization Review experience. Pre Certification or Pre Authorization experience Proficiency with computer skills including navigating multiple systems. Exceptional communication skills. Time efficient, highly organized, and ability to multitask. EducationAssociates Degree minimum OR Diploma RN required. Bachelors Degree preferred. Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$60,522. 00 - $129,615. 00This 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 ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on: 01/19/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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 SummaryThis Case Manager RN position is a fully remote position. Candidates from any state are welcome to apply, however, preference is for candidates in compact RN states. Normal Working Hours: Monday-Friday 9:00am - 5:30pm (9:00am being the earliest start time) in the time zone of residence. Team is open to varying hours until 8:00pm EST. There is a late shift rotation until 8:00pm EST and holiday on-call as needed. There is no travel 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 consider 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 QualificationsMust be a Registered Nurse with active current and unrestricted RN licensure in state of residence. Must have the ability to obtain multi-state/compact licensure and the ability to be licensed in all states. CVS supporting the cost of required licensure3+ years clinical practice experience as an RN required Must be willing and able to work Monday through Friday 9:00am - 5:30pm (9:00am being the earliest start time) in the time zone of residence. Team is open to varying hours until 8:00pm EST. There is a late shift rotation until 8:00pm EST and holiday on-call as needed1+ years of MS Office Suites (Outlook, Word, Excel) experience Preferred QualificationsCompact RN licensure Case management experience preferred. Case Manager Certification. EducationAssociates degree required BSN preferred Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$60,522. 00 - $129,615. 00This 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 ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on: 12/31/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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 SummaryThis Case Manager RN position is a fully remote position. Candidates from any state are welcome to apply, however, preference is for candidates in compact RN states. Normal Working Hours: Monday-Friday 9:00am - 5:30pm (9:00am being the earliest start time) in the time zone of residence. Team is open to varying hours until 8:00pm EST. There is a late shift rotation until 8:00pm EST and holiday on-call as needed. There is no travel 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 consider 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 QualificationsMust be a Registered Nurse with active current and unrestricted RN licensure in state of residence. Must have the ability to obtain multi-state/compact licensure and the ability to be licensed in all states. CVS supporting the cost of required licensure3+ years clinical practice experience as an RN required Must be willing and able to work Monday through Friday 9:00am - 5:30pm (9:00am being the earliest start time) in the time zone of residence. Team is open to varying hours until 8:00pm EST. There is a late shift rotation until 8:00pm EST and holiday on-call as needed1+ years of MS Office Suites (Outlook, Word, Excel) experience Preferred QualificationsCompact RN licensure Case management experience preferred. Case Manager Certification. EducationAssociates degree required BSN preferred Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$60,522. 00 - $129,615. 00This 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 ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on: 12/31/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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. Job SummaryThe 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 Care Manager 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 QualificationsMust have active and unrestricted Registered Nurse (RN) licensure in the state of Ohio OR compact 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 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 virtually3+ years of nursing experience2+ years of case management, discharge planning and/or home healthcare coordination experience Preferred QualificationsExperience 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-SpanishEducationAssociate'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) LicenseMust have active and unrestricted Registered Nurse (RN) licensure in the state of OhioState-specific license required prior to start date (internal candidates) Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$54,095. 00 - $116,760. 00This 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 ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on: 01/02/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

This program aims to develop RN-to-BSN students to be ready for the real world. CVS Health accomplishes this goal by not only meeting the academic standards of the school, but by providing students with a well-rounded experience that includes specialized online training, patient interaction, visibility to our EMR and the opportunity to work in a unique setting in health care. Our preceptors have a passion for teaching and sharing their knowledge. Our RNs have exceptional clinical skills and have worked hard to become experts in the specialty skills required as Case Manger RNs. CVSH preceptors provide an outstanding educational experience to each of their students. CVSH's preceptor program offers the most unique experience available because students are more than just enhancing their nursing skills but gaining:- Practical education including health assessments, customer care, insurance procedures, and use of evidence-based guidelines;- Exposure to the case management care model of service delivery;- An understanding of how a corporation relates to and supports the advancement of clinical practice;- A variety of clinical rotation locations and schedules. Required Qualifications:You must be enrolled in an RN-to-BSN program that has partnered with CVS Health. You must have an Associate's Degree ADN in Nursing. You must have at least one year of experience as an RN. You must have an RN license in the state in which you will precept. You must have a driver's license and your own form of transportation. COVID Vaccine Required:YesCOVID-19 Vaccination Requirement:CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of clinicals and to attest to your vaccination status or apply for a reasonable accommodation from your school within the first 10 days. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin your clinicals. This job does not have an application deadline, as CVS Health accepts applications on an ongoing basis. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

This program aims to develop RN-to-BSN students to be ready for the real world. CVS Health accomplishes this goal by not only meeting the academic standards of the school, but by providing students with a well-rounded experience that includes specialized online training, patient interaction, visibility to our EMR and the opportunity to work in a unique setting in health care. Our preceptors have a passion for teaching and sharing their knowledge. Our RNs have exceptional clinical skills and have worked hard to become experts in the specialty skills required as Case Manger RNs. CVSH preceptors provide an outstanding educational experience to each of their students. CVSH's preceptor program offers the most unique experience available because students are more than just enhancing their nursing skills but gaining:- Practical education including health assessments, customer care, insurance procedures, and use of evidence-based guidelines;- Exposure to the case management care model of service delivery;- An understanding of how a corporation relates to and supports the advancement of clinical practice;- A variety of clinical rotation locations and schedules. Required Qualifications:You must be enrolled in an RN-to-BSN program that has partnered with CVS Health. You must have an Associate's Degree ADN in Nursing. You must have at least one year of experience as an RN. You must have an RN license in the state in which you will precept. You must have a driver's license and your own form of transportation. COVID Vaccine Required:YesCOVID-19 Vaccination Requirement:CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of clinicals and to attest to your vaccination status or apply for a reasonable accommodation from your school within the first 10 days. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin your clinicals. This job does not have an application deadline, as CVS Health accepts applications on an ongoing basis. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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. Title: Registered NurseCompany: Oak Street HealthRole Description:The purpose of a Registered Nurse at Oak Street Health is to build strong relationships with Oak Street Health patients by coordinating their care and providing a seamless experience to patients and their support team. At Oak Street Health you will use an integrated approach toward achieving desired patient outcomes by utilizing standards, guidelines and pathways for care delivery. Through clinical assessment, intervention and education you will ensure our patients are provided competent nursing care in a timely manner. Our Registered Nurses drive quality care, it is of vital importance that our nurses incorporate data and information to improve care and enhance our patient outcomes. You will work to create an engaging and welcoming environment through team communication and delegation to empower other members of the care team to deliver the best care to our patients. Our Registered Nurses report to the Practice Manager or Nurse Supervisor (where applicable). Core Responsibilities:Provide competent nursing care by displaying proficiency in this role and executing job responsibilities in a safe and consistent manner Respond to incoming telephonic requests in a dependable manner, ensuring we are responsive to their needs and exceeding expectations Provide clinically competent triage and symptom management to patients who may or may not be physically present Utilize standardized protocols for medication management, prescription refills and prior authorizations. Conduct thorough and accurate reviews of patient medications and update as needed Provide comprehensive education and direct patient care, particularly around chronic conditions; may occur in person, over the phone or in group settings Actively collaborate and monitor the implementation and progress of the care plan for patients on multiple provider panels Form relationships with patients and their caregivers to support preventative care and ED/hospital diversion where appropriate Create a welcoming and engaging environment to meet the needs of our patients, communities, families and teams where they are Delegation of activities to other clinical care team members to support the needs of our patients Participate in care team meetings to discuss patient care and clinic operations Deliver an exceptional patient experience through service, responsiveness and respectful care Perform point of care testing, procedures and specimen collection (including phlebotomy) as needed Performs other related duties as assigned What we're looking for Required Qualifications:Active Registered Nurse (RN) Licensure in good standing with the applicable state BLS CertificationElectronic Medical Record (EMR) experience Ability to maintain patient confidentiality and process information in a confidential manner US work authorization Ability to assess patients without face-to face interaction, strong communication and assessment skill Strongly Preferred Qualifications:Ability to collaborate and communicate with members of an interdisciplinary care team Excellent computer skills with ability to read, interpret and analyze data from various computer systems Effective problem solving and prioritization skills2+ years of healthcare experience, working as an RNPreferred Qualifications:Previous experience in clinic setting Ability to work independently Fluency in Spanish, Polish, Russian, or other languages spoken by people in the communities we serve Anticipated Weekly Hours40Time TypeFull time Pay RangeThe typical pay range for this role is:$54,095. 00 - $116,760. 00This 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 ************* cvshealth. com/us/en/benefits We anticipate the application window for this opening will close on: 05/01/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

This program aims to develop RN-to-BSN students to be ready for the real world. CVS Health accomplishes this goal by not only meeting the academic standards of the school, but by providing students with a well-rounded experience that includes specialized online training, patient interaction, visibility to our EMR and the opportunity to work in a unique setting in health care. Our preceptors have a passion for teaching and sharing their knowledge. Our RNs have exceptional clinical skills and have worked hard to become experts in the specialty skills required as Case Manger RNs. CVSH preceptors provide an outstanding educational experience to each of their students. CVSH's preceptor program offers the most unique experience available because students are more than just enhancing their nursing skills but gaining:- Practical education including health assessments, customer care, insurance procedures, and use of evidence-based guidelines;- Exposure to the case management care model of service delivery;- An understanding of how a corporation relates to and supports the advancement of clinical practice;- A variety of clinical rotation locations and schedules. Required Qualifications:You must be enrolled in an RN-to-BSN program that has partnered with CVS Health. You must have an Associate's Degree ADN in Nursing. You must have at least one year of experience as an RN. You must have an RN license in the state in which you will precept. You must have a driver's license and your own form of transportation. COVID Vaccine Required:YesCOVID-19 Vaccination Requirement:CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of clinicals and to attest to your vaccination status or apply for a reasonable accommodation from your school within the first 10 days. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin your clinicals. This job does not have an application deadline, as CVS Health accepts applications on an ongoing basis. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

This program aims to develop RN-to-BSN students to be ready for the real world. CVS Health accomplishes this goal by not only meeting the academic standards of the school, but by providing students with a well-rounded experience that includes specialized online training, patient interaction, visibility to our EMR and the opportunity to work in a unique setting in health care. Our preceptors have a passion for teaching and sharing their knowledge. Our RNs have exceptional clinical skills and have worked hard to become experts in the specialty skills required as Case Manger RNs. CVSH preceptors provide an outstanding educational experience to each of their students. CVSH's preceptor program offers the most unique experience available because students are more than just enhancing their nursing skills but gaining:- Practical education including health assessments, customer care, insurance procedures, and use of evidence-based guidelines;- Exposure to the case management care model of service delivery;- An understanding of how a corporation relates to and supports the advancement of clinical practice;- A variety of clinical rotation locations and schedules. Required Qualifications:You must be enrolled in an RN-to-BSN program that has partnered with CVS Health. You must have an Associate's Degree ADN in Nursing. You must have at least one year of experience as an RN. You must have an RN license in the state in which you will precept. You must have a driver's license and your own form of transportation. COVID Vaccine Required:YesCOVID-19 Vaccination Requirement:CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of clinicals and to attest to your vaccination status or apply for a reasonable accommodation from your school within the first 10 days. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin your clinicals. This job does not have an application deadline, as CVS Health accepts applications on an ongoing basis. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.