Registered Nurse Case Manager

Aetna Case ManagerWe'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.Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members' health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country.Facilitate the delivery of appropriate benefits and healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements, and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies.Our Case Managers use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost effective outcomes.Fundamental Components & Physical RequirementsActs as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care.Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician's office to provide ongoing case management services.Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client's appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate.Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person.Prepares all required documentation of case work activities as appropriate.Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes.May make outreach to treating physician or specialists concerning course of care and treatment as appropriate.Provides educational and prevention information for best medical outcomes.Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources.Conducts an evaluation of members/clients' needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data.Utilizes case management processes in compliance with regulatory and company policies and procedures.Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work.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/client's overall wellness through integration.Monitors member/client progress toward desired outcomes through assessment and evaluation.Required Qualifications3+ years clinical practical experience preferenceCandidate must have the ability to travel up to 50% within Chicago –Zip Codes: 60616, 60608Candidate must have active and unrestricted Registered Nurse (RN) License in Illinois (IL)Candidate must have a valid and active driver's license and possess reliable transportationPreferred Qualifications2+ years case management, discharge planning and/or home health care coordination experienceConfidence working at home/independent thinker, using tools to collaborate and connect with teams virtuallyAbility to travel within a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs ariseExcellent analytical and problem-solving skillsEffective communications, organizational, and interpersonal skillsAbility to work independentlyProficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applicationsEfficient and effective computer skills including navigating multiple systems and keyboardingLive near zip codes 60616, 60608Certified Case ManagerBilingual in Cantonese/EnglishEducationAssociates Degree or Nursing Diploma (REQUIRED)Bachelor's Degree (PREFERRED)Anticipated Weekly Hours 40Time Type Full timePay Range The typical pay range for this role is:$66,575.00 - $142,576.00This 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 peopleWe take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.Additional details about available benefits are provided during the application process and on Benefits Moments.We anticipate the application window for this opening will close on: 10/05/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.