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Job Information

CVS Health Case Manager RN Registered Nurse in Arizona

Job Description

Remote role.Schedule is Monday-Friday standard business hours.No nights, no weekends and no holidays.Nurse Case Manager is responsible for telephonicallyassessing, planning, implementing and coordinating allcase management activities with members to evaluate themedical needs of the member to facilitate the member’soverall wellness. Develops a proactive course of action toaddress issues presented to enhance the short and longtermoutcomes as well as opportunities to enhance amember’s overall wellness through integration. Servicesstrategies policies and programs are comprised of networkmanagement and clinical coverage policies.Through the use of clinical tools and information/datareview, conducts an evaluation of member's needs andbenefit plan eligibility and facilitates integrative functions aswell as smooth transition to Aetna programs and plans.Applies clinical judgment to the incorporation of strategiesdesigned to reduce risk factors and barriers and addresscomplex health and social indicators which impact careplanning and resolution of member issues. Assessmentstake into account information from various sources toaddress all conditions including co-morbid and multiplediagnoses that impact functionality. Assessments includethe member’s level of work capacity and relatedrestrictions/limitations. Using a holistic approach assessthe need for a referral to clinical resources for assistancein determining functionality. Consults with supervisor andothers in overcoming barriers in meeting goals andobjectives, presents cases at case conferences formultidisciplinary focus to benefit overall claimmanagement. Utilizes case management processes incompliance with regulatory and company policies andprocedures. Utilizes interviewing skills to ensure maximummember engagement and discern their health status andhealth needs based on key questions and conversation.

Required Qualifications

5 years clinical practice experience. (Renal, Diabetes,Hypertension, Holistic, Oncology)Technology proficientIndependent workerExcellent time managerLICENSE: RN with current unrestricted state licensurerequired

Preferred Qualifications

Case Management in an integrated model preferred.Bilingual preferred


Associate's degree or equivalent experience

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.