Case Manager, Registered Nurse - Field - Forbes Hospital, PA

Program Overview Help us elevate patient care to a whole new level. Join the Aetna Clinical Collaboration (ACC) team - an innovative and growing, community-based care management model designed to transform how we serve our members. ACC utilizes best-in-class clinical and operating models to deliver meaningful, high-impact care where it matters most. ACC is a member-centric, team-delivered approach that meets members where they are. Through compassionate engagement and strong communication, our care teams collaborate with members, providers, and community organizations to address the full continuum of healthcare needs, including medical, behavioral, and social determinants of health. This is an exciting opportunity to be part of a growing program with national expansion, offering the chance to help shape care delivery in new markets and have a life-changing impact on the members we serve. Family Summary / Mission This role supports the delivery of appropriate benefits and healthcare services by facilitating eligibility determination, promoting wellness activities, and advancing successful, timely health outcomes. The team develops, implements, and supports health strategies, policies, and programs that ensure effective care delivery and overall member wellness. Services span network management, clinical coverage, and evidence-based policies. Position Summary / Mission The ACC Case Manager applies a collaborative, member-centered approach to assessment, care planning, coordination, evaluation, and advocacy to address the comprehensive health needs of individuals and families. This is an on-site, hospital-based role supporting members receiving care at Forbes Hospital and requires consistent in-person engagement with members, providers, and multidisciplinary care teams. Candidates must reside within reasonable driving distance of the facility to support reliable on-site presence and timely care coordination. Fundamental Components & Physical Requirements Serve as a liaison between members/clients, families, employers, providers, insurance carriers, and healthcare personnel as appropriate. Implement and coordinate case management activities for catastrophic and chronically ill members across the continuum of care, including consultant referrals, home care, community resources, and alternative levels of care. Interact with members/clients both telephonically and in person while working on-site at Forbes Hospital, including meeting with members during inpatient admissions. Assess medical, functional, and vocational status to develop and implement individualized plans of care that support optimal health outcomes, benefits eligibility, and timely return to work or baseline functioning. Communicate effectively with stakeholders including medical providers, attorneys, employers, and insurance carriers. Prepare timely and accurate documentation of all case management activities. Collaborate with internal multidisciplinary teams to support optimal member outcomes. Conduct outreach to treating physicians and specialists to support appropriate care planning. Provide education and preventive guidance to promote best clinical outcomes. Apply applicable laws, regulations, and payer requirements related to rehabilitation and case management services. Monitor member progress toward desired outcomes and adjust care plans as needed. Develop proactive strategies to address complex needs and support both short- and long-term wellness outcomes. Required Qualifications Reliable transportation and the ability to consistently meet onsite, hospital-based work requirements at Forbes Hospital, PA up to 50-75% Candidate must have active and unrestricted Registered Nurse (RN) License in Pennsylvania 3+ years of clinical experience, preferably with Medicare and Commercial populations Ability to work independently within a hospital-based environment Strong analytical, problem-solving, organizational, and communication skills Proficiency in MS Word, Excel, Outlook, PowerPoint, and proprietary clinical systems Efficient computer skills, including navigating multiple systems and keyboarding Preferred Qualifications 3+ year of experience in care management, discharge planning, or home health coordination Willingness to obtain multi-state RN licensure (company supported) National certification (CRC, CDMS, CRRN, COHN, or CCM) Education Associate’s Degree in Nursing with equivalent clinical experience (REQUIRED) Bachelor's Degree (PREFERRED) License Active and unrestricted Registered Nurse (RN) License in Pennsylvania Technical and Logistical Requirements Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency. Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings. Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace). Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links. Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues. Future Growth: Openness to learning new skills in the future as the workplace environment evolves Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $60,522.00 - $129,615.00. This 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. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 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. 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: 11/30/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area. #J-18808-Ljbffr CVS Health