Case Manager Registered Nurse

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.

The Case Manager RN role is telework/hybrid and applicant must live in the state of North Carolina. Normal working hours are Monday through Friday 9:00am – 5:30pm EST. Occasional evening, weekend, and holiday shifts may be required. 0-10% travel is possible, including but not limited to trips to the High Point office for customer meetings.

• Telephonically assess, plan, implement, and coordinate all case‑management activities with members to evaluate their medical needs and facilitate overall wellness.
• Develop a proactive course of action to address issues and enhance short and long‑term outcomes, integrating opportunities to improve member wellness.
• Use clinical tools and data review to evaluate members’ needs and benefit plan eligibility, facilitate integrative functions, and transition to Aetna programs and plans.
• Apply clinical judgment to incorporate strategies that reduce risk factors and barriers, addressing complex health and social indicators that impact care planning and resolution of member issues.
• Assess members using information from multiple sources to address co‑morbid conditions and multiple diagnoses that affect functionality.
• Review prior claims to address potential impact on current case management and eligibility.
• Include assessment of the member’s level of work capacity and related restrictions or limitations.
• Utilize a holistic approach to assess the need for a referral to clinical resources for assistance in determining functionality.
• Consult with supervisor and others to overcome barriers, present cases at case conferences for multidisciplinary focus, and benefit overall claim management.
• Employ case‑management processes in compliance with regulatory and company policies and procedures.
• Use interviewing skills to ensure maximum member engagement and accurately discern health status and needs based on key questions and conversation.

• Active and unrestricted RN license in North Carolina.
• 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 by company).
• At least 2 years of clinical RN experience.
• All clinical experience is considered, including Emergency Department, Home Health, Hospice, Operating Room, ICU, NICU, Telemetry, Medical/Surgical, Orthopedics, Long‑Term Care, and Infusion nursing.

• Certified Case Manager (CCM) certification.
• 3+ years’ experience with Microsoft Office Suite.
• Experience with case management in an integrated model.
• Discharge planning experience.
• Managed care experience.
• BSN degree.

• Associate’s Degree in Nursing.

Anticipated weekly hours: 40
Time type:
Full time

The typical pay range for this role is $54,095.00 – $. The actual offer will depend on experience, education, geography, and other factors. This position is eligible for a CVS Health bonus, commission, or short‑term incentive program in addition to the base pay.

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. Benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

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