Case Manager, Registered Nurse (Field - Illinois)

At CVS Health, were building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Program Overview

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.

Summary / Mission

Facilitate the delivery of appropriate benefits and / or 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.

Position Summary / Mission

Our case managers use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individuals and familys comprehensive health needs through communication and available resources to promote quality, cost?effective outcomes.

Fundamental Components & Physical Requirements

• Acts 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 physicians 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 / clients 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 members / clients overall wellness through integration.
• Monitors member / client progress toward desired outcomes through assessment and evaluation.

Required Qualifications

Preferred Qualifications

Certified Case Manager is preferred

Education

Associates Required, Bachelor's preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is :

$66,575.00 - $142,576.00

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 our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include :

For more information, visit

We anticipate the application window for this opening will close on : 11 / 21 / 2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

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