Experienced Remote RN Case Manager - Telephonic and Face-to-Face Case Management for Aetna One Advocacy

Bringing Our Heart to Every Moment of Your Health at CVS Health

At CVS Health, we're driven by a singular purpose: to bring our heart to every moment of your health. This guiding principle underpins our commitment to delivering enhanced, human-centric health care in a rapidly evolving world. As a leader in the health care industry, we're dedicated to making health care more personal, convenient, and affordable. Our Heart At Work Behaviors support this purpose, empowering every team member to play a vital role in transforming our culture and accelerating innovation.

About Aetna One Advocacy (A1A)

Aetna One Advocacy is Aetna's premier service and clinical offering, creating industry-leading solutions for our customers and members nationwide. As part of Aetna, a CVS Health company, A1A embodies our mission to meet each member at every stage of their health care journey. By integrating population health and customer service, we provide a high-touch, high-tech member advocacy service that combines data-driven processes with the expertise of highly trained clinical and concierge member services teams. Our embedded customer-dedicated service and clinical pods maximize inbound and outbound touchpoints to address members' needs and foster behavior change.

Job Summary: RN Case Manager

We're seeking an experienced RN Case Manager to join our Aetna One Advocacy team in a remote capacity, based in Arizona. This role requires a strong clinical background, excellent communication skills, and the ability to work independently in a fast-paced environment. As an RN Case Manager, you'll be responsible for telephonically and/or face-to-face assessing, planning, implementing, and coordinating case management activities with members to evaluate their medical needs and facilitate overall wellness.

Key Responsibilities:

• Develop a proactive course of action to address member issues, enhancing short and long-term outcomes and overall wellness through integration.
• Conduct comprehensive evaluations of members' needs and benefit plan eligibility using clinical tools and data review, facilitating smooth transitions to Aetna programs and plans.
• Apply clinical judgment to incorporate strategies that reduce risk factors and barriers, addressing complex health and social indicators that impact care planning and issue resolution.
• Assess information from various sources to address all conditions, including co-morbid and multiple diagnoses that impact functionality.
• Review prior claims to address potential impacts on current case management and eligibility.
• Assess members' level of work capacity and related restrictions/limitations, using a holistic approach to determine the need for referrals to clinical resources.
• Consult with supervisors and other stakeholders to overcome barriers in meeting goals and objectives, presenting cases at case conferences for multidisciplinary focus.
• Utilize case management processes in compliance with regulatory and company policies and procedures.
• Employ effective interviewing skills to ensure maximum member engagement, discerning their health status and needs through key questions and conversation.

Essential Qualifications:

• A Registered Nurse with an unrestricted license in their state of residence, multi-state/compact privileges, and willingness to obtain licenses in all non-compact states.
• 3+ years of clinical practice experience as an RN.
• Residence within commutable distance of Chandler, Arizona (typically within 45 minutes maximum).
• Associate's Degree in Nursing; BSN preferred.

Preferred Qualifications:

• Case Management experience in an integrated model.
• Certified Case Manager (CCM) certification.

What We Offer

At CVS Health, we provide a competitive compensation package, including a salary range of $54,095.60 - $116,760.80, depending on experience, education, and geography. In addition to your base salary, you may be eligible for a CVS Health bonus, commission, or short-term incentive program.

Our comprehensive benefits package includes:

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan and Employee Stock Purchase Plan.
• Fully-paid term life insurance and short-term and long-term disability benefits.
• Well-being programs, education assistance, and free development courses.
• CVS store discount and discount programs with participating partners.
• Paid Time Off (PTO) and paid holidays throughout the calendar year.

Career Growth and Development

As an RN Case Manager at Aetna One Advocacy, you'll have opportunities for career growth and professional development. Our dynamic environment encourages innovation, learning, and collaboration, allowing you to expand your skills and expertise. You'll be part of a talented team dedicated to delivering exceptional member experiences and driving positive health outcomes.

Work Environment and Culture

This role is primarily remote, with initial in-office training in Chandler, Arizona, lasting approximately 4 months. After training, you'll work from home with occasional in-office workdays scheduled in advance. We require flexibility for onsite work shifts as needed by the business. Our culture values diversity, inclusivity, and teamwork, providing a supportive environment where you can thrive.

Join Our Team

If you're a compassionate and experienced RN looking for a challenging and rewarding role, we encourage you to apply. As an RN Case Manager at Aetna One Advocacy, you'll play a vital role in shaping the future of health care and making a meaningful difference in the lives of our members. Apply now and let's discuss how you can become a part of our success story.

Application Window: The application window for this opening is expected to close on January 31, 2025.

Equal Employment Opportunity: CVS Health is an equal employment opportunity employer, and we consider qualified applicants with arrest or conviction records in accordance with all federal, state, and local laws.