Case Manager Registered Nurse

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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
**** The Case Manager RN role is 100% remote work from home and candidates must have an active Illinois RN licensure (but does not need to live in Illinois).
** Normal

Working Hours:

Monday through Friday 9:00am – 5:30pm in time zone of residence.
Occasional evening, weekend, and holiday shifts per the needs of the team.
No travel is 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 take into account 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 Qualifications**
- ** Must have an active Illinois RN licensure (does not need to live in Illinois).**-Multiple State RN licensure is welcomed but not required. If chosen must be willing and able to obtain multiple state RN licensure after hire (expenses paid for by company)-2+ years of clinical experience as an RN-All clinical experience will be considered, such as Emergency Department, Home Health, Hospice, Operating Room, ICU, NICU, Telemetry, Medical / Surgical, Orthopedics, Long Term Care, and Infusion nursing.
** Preferred Qualifications**-Certified Case Manager (CCM) certification  
-3+ years’ experience with Microsoft Office Suite  
-Case Management in an integrated model  
-Discharge Planning experience  
-Managed care experience-BSN preferred    
** Education*
* -Associates Degree in Nursing
** Anticipated Weekly Hours
** 40
* * Time Type
** Full time
** Pay Range
** The typical pay range for this role is:$66,575.00 - $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.

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