• Job Description

  Req#: R0664951

  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.

  Position Summary

  Working hours : Monday through Friday 9 :00am to 6:00pm CST. There are c urrently no nights, no weekends, and no holidays; however, it is subject to change based on business needs.

  
  The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member and to help facilitate the member’s overall wellness.

  - 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 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 consider 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 plan.
  - Assessments include the member’s level of work capacity and related restrictions/limitations.
  - Using a holistic approach to assess the need for referral to clinical resources for assistance.
  - 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, current and unrestricted RN licensure in the state of residence and be willing to apply for a Compact RN (fees pd by company0

  5 years clinical practice experience as an RN

  Must be able to work Monday through Friday 9 :00am to 6:00pm CST. There are c urrently no nights, no weekends, and no holidays; however, it is subject to change based on business needs.

  Preferred Qualifications

  6+ months Case Management or Utilization Management experience

  Case Management Certification
  

  Education

  Associate Degree required

  BSN 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

  • Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

  • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

  • Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

  For more information, visit https://jobs.cvshealth.com/us/en/benefits

  We anticipate the application window for this opening will close on: 08/06/2025

  Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

• About the company

  At CVS Health, we share a clear purpose: helping people on their path to better health. Through our health services, plans and community pharmacists, we’re pioneering a bold new approach to total health. Making quality care more affordable, accessible, simple and seamless, to not only help people get well, but help them stay well in body, mind and spirit.

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