Case Manager Registered Nurse (Field Must reside in Southwestern Region of Virginia)

- Coordinates all case management activities with members to evaluate medical needs and to facilitate the overall wellness of members.

- Develops strategy to address issues to outcomes and opportunities to enhance member's overall wellness through integration. Instructs programs and procedures in compliance with network management and clinical coverage policies.

- Executes evaluation of member needs and benefit plan eligibility and facilitates member transition to the organization's programs and plans.

Applies advanced clinical judgement to incorporate strategies designed to reduce risk factors and barriers, and to address complex health indicators that impact care planning and resolution of member issues.

- Handles reviews of prior claims to address potential impact on current case management and eligibility.

- Creates a holistic approach to assess the need for referrals to clinical resources and to assist in determining functionality.

- Ensures case management processes follow organization and regulatory requirements.

- Implements systems to maximize member engagement, discern health status and needs, and to assess member levels of work capacity and restrictions.

- Coaches and trains junior colleagues in techniques, processes, and responsibilities

Required Qualifications

- Must reside in the Southwestern region of Virginia, preferably in Abingdon, Bristol, Tazewell, Wise, Wytheville, Galax, or Pulaski

- Must possess reliable transportation and be willing and able to travel up to 25-50% of the time to meet members face to face in Richmond and throughout the Southwestern Region of Virginia. Mileage is reimbursed per our company expense reimbursement policy

- Drivers License is required

- Must have an active, current, and unrestricted RN Licensure in Virginia

- 3+ years clinical practice experience as an RN required

- 2+ years' experience using personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)

- 2+ years of Case Management experience

Preferred Qualifications

-Ability to organize, multitask, prioritize and effectively adapt to a fast-paced changing environment.

-Basic awareness of problem solving and decision making skills

-Effective communication skills, both verbal and writtenEducation

- Associates degree in Nursing required

- Bachelor's in Science & Nursing preferred Anticipated Weekly Hours
40Time Type
Full timePay Range

The typical pay range for this role is:$60,522.00 - $129,615.00This 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 peopleWe 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:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 05/25/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work. CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.