Case Manager Registered Nurse - Medicare (Remote)

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Information Work Schedule: Monday-Friday 8:00am-5:00pm Eastern Time Program Overview Help us elevate our patient care to a whole new level! Join our Community Care team as an industry leader in serving our members by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Community Care members. Community Care is a member centric, team-delivered, community-based care management model that joins members where they are. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country. Family Summary/Mission Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies. Position Summary Community Care Case Manager use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes.

Responsibilities

Requirements

• • Active and unrestricted RN Compact licensure. • Minimum 3+ years clinical practical experience preference: (Diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members. • Minimum 2+ years Case Management, discharge planning and/or home health care coordination experience. ​Preferred Qualifications • Excellent analytical and problem-solving skills. • Effective communications, organizational, and interpersonal skills. • Ability to work independently (may require working from home). • Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications. • Efficient and Effective computer skills including navigating multiple systems and keyboarding. • Willing and able to obtain multi state RN licenses if needed, company will provide. • Certified Case Manager is preferred. • Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) is preferred, but not required. • Associates degree or Nursing diploma require. • Bachelor’s 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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will close on: 09/16/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

About CVS Health / Aetna

CVS Health/Aetna hires nurses for remote positions in health plan administration and virtual care delivery. Roles include Appeals Nurse Consultants who review clinical complaints and appeals for Medicare/Medicaid plans while ensuring regulatory compliance; Utilization Management Nurse Consultants who review services for medical necessity, coordinate discharge planning, and collaborate with providers to ensure appropriate care; and MinuteClinic Virtual Care Nurse Practitioners who provide direct patient care through a remote platform for patients 18 months and older. These positions require clinical expertise to support members in receiving safe, appropriate, and cost-effective care while meeting state and federal requirements.