Job Description

RN 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.

This RN Case Manager role is part of Aetna One Advocacy (A1A) and requires in office training and ongoing work in New Albany, Ohio. There is a requirement to live within a commutable distance of New Albany, Ohio (typically within 45 minutes maximum).

The expected start date for the cohort is November 9th, 2026. The initial in office training will last for approximately 4 months. Once office training is complete, the role is work from home with occasional in office workdays scheduled in advance with the employee. There will be an expectation that the Case Manager works in the office at least one time per quarter for further training but it may be more often and notice will be provided. Normal working hours: 8am-4:30pm EST. Once training is completed, the Case Manager will work occasional later shifts per month on a team rotation and to meet member needs. There are no weekend shifts. Flexibility is required for onsite work shifts per the need of the business.

Aetna One Advocate is Aetna's premier service and clinical offering for Aetna nation-wide and creates industry-leading solutions for our customers and members. The model is a fully integrated population health and customer service solution for large plan sponsors. The high-touch, high-tech member advocacy service combines data-driven processes with the expertise of highly trained clinical and concierge member services. Our mission is to meet each member at every aspect of their health care journey. Our embedded customer-dedicated service and clinical pods allow maximization of inbound and outbound touchpoints to solve members' needs and create behavior change. Our data analytics, white-glove service and end-to-end ownership of member support creates a trusted partner in health. This is an exciting time to join Aetna, a CVS Health company, in our journey to change the way healthcare is delivered today. We are health care innovators.

The RN Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness.

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 overall wellness through integration.

Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.

Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.

Assessments consider information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.

Reviews prior claims to address potential impact on current case management and eligibility.

Assessments include the member's level of work capacity and related restrictions/limitations.

Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.

Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.

Utilizes case management processes in compliance with regulatory and company policies and procedures.

Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Required:

- A Registered Nurse that must hold an unrestricted license in their state of residence, preferably with multi-state/compact privileges and be willing and able to be licensed in all non-compact states

- Upon hire, it will be required to obtain all 50 state licenses.

- 3+ years of clinical practice experience required as an RN

- There is a requirement to live within a commutable distance of New Albany, Ohio (typically within 45 minutes maximum).

Preferred:

- Case Management in an integrated model

- Certified Case Manager (CCM) certification

- Oncology Experience

- Bilingual in English and a 2nd language

- Diabetes Care and Education Specialist

Education:

- Associates Degree in Nursing required.

- BSN preferred.

Anticipated Weekly Hours: 40

Time Type: Full time

Pay Range: $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.

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. 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.

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