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 Summary This Case Manager RN position is 100% remote, no travel is expected with this position. Normal Working Hours: Monday through Friday, 8 hour shift between 8am to 5:30pm Arizona time The Nurse Case Manager is responsible for telephonically assessing, planning, implementing and coordinating all case management activities with members from our Federal Plans. The Case Manager is responsible to evaluate the medical needs of the member in order to facilitate and promote the member’s overall wellness. The Case Manager develops a proactive course of action to address issues presented to enhance the member's short and long term outcomes. • Apply data driven methods of identification of members to fashion individualized case management programs and/or referrals to alternative healthcare programs. • Conduct comprehensive clinical assessments. • Evaluate needs and develop flexible approaches based on member needs, benefit plans or external programs/services. • Advocate for patients to the full extent of existing health care coverage. • Promote quality, cost effective outcomes, and make suggestions to improve program/operational efficiency. • Identify and escalate quality of care issues through established channels. • Provide an expected very high level of customer service. • Utilize assessment techniques to determine member’s level of health literacy, technology capabilities, and/or readiness to change. • Utilize influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
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.
