Case Manager Registered Nurse – Integrated Care Management – Must reside in IL

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.

Program Overview: Join Aetna’s mission-driven team supporting dual-eligible members through the Dual Special Needs Plan (D-SNP FIDE). Our integrated care model addresses both medical and social determinants of health, serving members with complex needs through compassionate, coordinated care. As we expand into new markets, this role offers the opportunity to make a meaningful impact in the lives of vulnerable populations. Position Summary / Mission: The Care Manager Registered Nurse serves as a frontline advocate for members who may not be able to advocate for themselves. This role is responsible for assessing, planning, implementing, and coordinating case management activities to support members’ overall health and wellness. The Care Manager collaborates with members, providers, and interdisciplinary teams to overcome barriers and promote optimal outcomes.

Develop proactive care plans to address identified health and social issues, enhancing short- and long-term outcomes. Conduct comprehensive assessments using clinical tools and data sources to evaluate member needs and benefit eligibility. Apply clinical judgment to reduce risk factors and address complex health and social indicators. Use a holistic approach to determine referrals to clinical and interdisciplinary resources. Collaborate with supervisors and care teams to overcome barriers and present cases at interdisciplinary case conferences. Utilize motivational interviewing techniques to engage members and assess health status. Document case management activities in compliance with regulatory and company policies.