Case Manager, Registered Nurse - Field (North Side Chicago)

Position Overview At CVS Health, we’re building a world of health around every consumer with dedicated colleagues passionate about transforming health care. As the nation’s leading health solutions company, our local presence, digital channels and over 300,000 purpose-driven colleagues enable us to care for people in a connected, convenient, and compassionate way. This full-time telework role (with 50-75% travel in the Northside of Chicago) requires working Monday through Friday, 8:00 AM - 5:00 PM CST. Help us elevate patient care with our Aetna team, serving dual eligible populations by employing best-in-class operating and clinical models while addressing members’ complex health and social challenges. Compensation: The typical pay range for this role is $66,575.00 - $142,576.00. In addition to base pay, this position is eligible for bonus, commission, or short-term incentive programs.

Key Responsibilities

• Acts as a liaison with members/clients/families, employers, provider(s), insurance companies, and healthcare personnel as appropriate.
• Implements and coordinates case management activities for catastrophic cases and chronically ill members/clients, including consultant referrals, home care visits, community resources, and alternative levels of care.
• Interacts with members/clients telephonically or in person, including meetings at homes, worksites, or physician’s offices.
• Assesses and analyzes the medical and/or vocational status of injured, acute, or chronically ill members/clients to develop a plan of care that optimizes wellness, supports timely return to work, and determines benefit eligibility.
• Communicates with members/clients and other stakeholders (e.g., medical providers, attorneys, employers, insurance carriers) as appropriate.
• Prepares all required documentation of case work activities.
• Consults with internal multidisciplinary teams to help members/clients maximize health outcomes.
• Conducts outreach to treating physicians or specialists regarding the course of care as needed.
• Provides educational and prevention information for optimal medical outcomes.
• Applies all applicable laws, regulations, and special instructions from insurance carriers and referral sources.
• Conducts evaluations of members/clients’ needs and benefit plan eligibility using clinical tools and data.
• Utilizes case management processes in compliance with regulatory and company policies.
• Monitors member/client progress toward desired outcomes through regular assessment and evaluation.

Required Qualifications

• 3 years of clinical practical experience (preference required).
• Registered Nurse with an active state license in good standing within the region where job duties are performed.
• 2 years of case management, discharge planning, and/or home health care coordination experience.
• Confidence working at home; an independent thinker who effectively uses tools to collaborate virtually.
• Ability to travel within a designated geographic area for in-person case management activities as needed.
• Proficiency with standard corporate software applications including MS Word, Excel, Outlook, and PowerPoint, as well as proprietary systems.
• Efficient and effective computer skills, including navigating multiple systems and strong keyboarding ability.

Preferred Qualifications

• Excellent analytical and problem-solving skills.
• Effective communication, organizational, and interpersonal skills.
• Ability to work independently.
• Certified Case Manager.
• Bachelor of Science in Nursing.

Benefits & Perks

• Affordable medical plan options, a 401(k) plan with matching contributions, and an employee stock purchase plan.
• No-cost programs including wellness screenings, tobacco cessation, weight management programs, confidential counseling, and financial coaching.
• Benefit solutions addressing varied needs such as paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, and retiree medical access.

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