Case Manager, Registered Nurse - Southeast Region

Position Summary Help us elevate our patient care to a whole new level! Join our Community Care team as an industry leader in serving our members by utilizing best‑in‑class operating and clinical models. We collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Responsibilities Act as a liaison with members, families, employers, providers, insurance companies, and healthcare personnel. Implement and coordinate all case‑management activities relating to catastrophic cases and chronically ill members across the continuum of care, including consultant referrals, home‑care visits, community resources, and alternative levels of care. Interact with members telephonically or in person, and meet them in homes, worksites, or physician offices as needed. Assess and analyze injured, acute, or chronically ill members’ medical and vocational status, develop a plan of care, and optimize wellness and medical outcomes to facilitate timely return to work or optimal functioning. Communicate with members and stakeholders (medical providers, attorneys, employers, insurance carriers) telephonically or in person. Prepare all required documentation of case‑work activities. Consult with the internal multidisciplinary team to help members maximize health outcomes. Provide educational and prevention information for best medical outcomes. Apply all laws, regulations, and special instructions related to rehabilitation services and insurance carriers. Conduct evaluations of members’ needs and benefit plan eligibility, and facilitate integrative functions using clinical tools and data. Utilize case‑management processes in compliance with regulatory and company policies. Facilitate appropriate condition management, optimize overall wellness and medical outcomes, and ensure timely return to baseline or work. Develop a proactive course of action to address issues and enhance members’ short‑term and long‑term outcomes. Monitor members’ progress toward desired outcomes through assessment and evaluation. Required Qualifications Reside in the Southeast Region (FL, GA, AL, MS, NC, SC, TN). Hold an active and unrestricted Compact Registered Nurse (RN) license in a compact state. Have 3+ years of clinical practice experience with preference in diabetes, CHF, CKD, post‑acute care, hospice, palliative care, cardiac, or home health with Medicare members. Have 2+ years of case‑management, discharge planning, and/or home‑health care coordination experience. Dependents must have separate care arrangements during work hours; continuous care responsibilities during shift times are not permitted. Access to a private, dedicated space to conduct work effectively. Preferred Qualifications Excellent analytical, problem‑solving, and organizational skills. Effective communication and interpersonal skills. Ability to work independently. Certified Case Manager (CRC, CDMS, CRRN, COHN, or CCM). Efficient and effective computer skills, including navigating multiple systems and keyboarding. Willing and able to obtain multi‑state RN licenses if needed. Education & Licenses Associate’s Degree in Nursing (REQUIRED). Bachelor’s Degree in Nursing (PREFERRED). Active and unrestricted Compact RN license, living in a compact state. Pay Range The typical pay range for this role is: $54,095.00–$116,760.00. The actual base salary 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. Benefits Eligible for a comprehensive benefits package that includes medical, dental, and vision coverage; paid time off; retirement savings options; wellness programs; and other resources based on eligibility. Application Window The application window for this opening will close on: 06/12/2026. Equal Opportunity Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws. #J-18808-Ljbffr 4062 Aetna Resources, LLC