Case Manager, Registered Nurse - Field - Geisinger Community Medical Center, PA

Aetna Clinical Collaboration Case Manager

We'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.

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.

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.

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.

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 Geisinger Community Medical Center 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 Geisinger Community Medical Center, 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:

• Candidate must have active and unrestricted Registered Nurse (RN) License in the state of Pennsylvania (PA).
• 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 Microsoft Word, Excel, Outlook, PowerPoint, and proprietary clinical systems.
• Efficient computer skills, including navigating multiple systems and keyboarding.
• Reliable transportation and the ability to consistently meet on-site, hospital-based work requirements at Geisinger Community Medical Center.

Preferred Qualifications:

• 3+ year of experience in care management, discharge planning, home health coordination, or utilization management.
• Willingness to obtain multi-state Registered Nurse (RN) licensure.
• National certification (CRC, CDMS, CRRN, COHN, or CCM).

Education:

• Associate's Degree with equivalent clinical experience (REQUIRED).
• Bachelor's Degree (PREFERRED).

Anticipated Weekly Hours: 40

Time Type: Full time

Pay Range: $60,522.00 - $129,615.00

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 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.