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CVS Health Case Manager RN in New Albany, Florida

Job Description

Work from home flexible local travel may be required for auditing.Working hours will be Monday-Friday 8am-4:30pm ESTNo weekends or holidays will be required. Candidates are preferred to reside in OH however candidates from any state are able to apply. The Care Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. The CM process includes: assessing the member's health status and care coordination needs, inpatient review and discharge planning, developing and implementing the CM plan, monitoring and evaluating the plan and involving the Medical Director as indicated and closing the case as appropriate when the member has met discharge criteria. The responsibilities of this position are to apply data driven methods of identification of members to fashion individualized case management programs and/or referrals to alternative healthcare programs. Conducts comprehensive clinical assessments. Evaluates needs and develops flexible approaches based on member needs, benefit plans or external programs/services. Advocates for patients to the full extent of existing health care coverage. Promotes quality, cost effective outcomes and makes suggestions to improve program/operational efficiency. Identifies and escalates quality of care issues through established channels. Expectation is a very high level of customer service.

Required Qualifications

Must be a Registered Nurse with an unrestrictive licenseminimum 3+ years clinical experience.

COVID Requirements

CVS Health requires its Colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, or religious belief that prevents them from being vaccinated.

If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. In some states and roles, you may be required to provide proof of full vaccination before you can begin to actively work. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

If you are unable to be fully vaccinated due to disability, medical condition, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. In some states and roles, you may be required to have an approved reasonable accommodation before you can begin to actively work. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

CCM - Clinical Case Manager Managed Care experienceThe candidate has the ability to exercise independent and sound judgment, Has strong decision-making skills and well-developed interpersonal skills.Ability to manage multiple priorities, effective organizational and time management skills along with strong teamwork skills.Prior experience within a telephonic customer service center type of environment is preferred.Candidate must possess good computer skills.Fundamental components related to the Aetna One Premier program include but are not limited to;Utilizes assessment techniques to determine member’s level of health literacy, technology capabilities, and/or readiness to change.Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.Provides coaching, information, education and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.


Bachelor's degree

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.