Case Manager, Registered Nurse

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. Job Summary The Care Manager—Registered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible for coordinating care for members who often face multiple chronic medical and behavioral health conditions, as well as various social determinants of health (SDoH) needs. This role involves conducting comprehensive assessments to evaluate members’ needs and addressing SDoH challenges by connecting them with appropriate resources and support services. The Social Worker provides education and guidance to members and their families on managing chronic conditions and navigating the healthcare system. Additionally, the Care Manager develops and implements individualized care plans, monitors member progress, advocates for necessary services, and collaborates with the interdisciplinary care team to ensure optimal health outcomes. Accurate and timely documentation of assessments and interventions is essential, as is participation in team meetings to discuss member status and care strategies. Key Responsibilities 50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care. Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member’s identified needs. Provides evidence-based disease manag

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. Position Summary This is a remote work from home role anywhere in the US with virtual training. American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members. Key Responsibilities This position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients. Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits. 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 utilize information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at

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. Position Summary Community Care Case Manager use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes. 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 physician’s 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/client’s 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 stakeholder

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. RN Nurse Case Manager – Field- Location: Northern Virginia: Fairfax, Sterling, Reston, Ashburn and surrounding Virginia Areas Schedule: Mon-Fri 8:00-5:00 PM EST Travel: Up to75% Position Overview: We’re looking for a compassionate and motivated Registered Nurse Case Manager to join our team, supporting members in the Fairfax, Sterling, Reston, Ashburn and surrounding areas of Virginia. This is a field-based role that blends in-person visits with telephonic outreach to deliver coordinated, patient-centered care. What You’ll Do: As a Nurse Case Manager, you will play a critical role in improving the health and well-being of members by coordinating care, removing barriers, and supporting better outcomes. In this role, you will: Conduct comprehensive assessments (telephonic and face-to-face) to evaluate members’ medical, behavioral, and social needs Develop and implement personalized care plans that promote both short- and long-term wellness Coordinate care across providers, programs, and services to ensure a seamless experience for members Use clinical expertise and data insights to identify risks, gaps in care, and opportunities for intervention Support members with complex or multiple conditions by applying a holistic, whole-person app

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. Registered Nurse Case Manager – Field in Suffolk, Brooklyn, Kings and Queens and surrounding counties, NY Position Summary: This position is a field‑based Registered Nurse (RN) role responsible for conducting member assessments for new NY Better Health enrollees, annual reassessments, semiannual reviews, and change‑in‑condition visits. The nurse will complete 2–3 home visits per day, with all documentation expected within 24 hours of each assessment. The role requires extensive travel (up to 75%) across assigned Suffolk and Surrounding Counties, NY and close collaboration with the Scheduler/CM Assistant who coordinates Work hours are Monday–Friday, 8:30 a.m.–5:00 p.m. EST. Key Responsibilities: Initial Assessments — Conduct member assessments for new NY Better Health applicants. Reassessments — Perform annual, semiannual, and change‑in‑condition assessments per regulatory and plan requirements. Clinical Documentation — Submit complete, accurate documentation within 24 hours of each visit. Care Coordination — Communicate findings to interdisciplinary teams to support care planning. Travel & Scheduling — Maintain punctuality and reliability for 2–3 daily home visits coordinated by the scheduling team. Independent Work — Operate effectively in a remote/telephonic environment while collaboratin

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. Position Summary: This RN Case Manager role is part of Aetna One Advocacy (A1A) and requires in office training and ongoing work in High Point, Nc. There is a requirement to live within a commutable distance of High Point, Nc (typically within 45 minutes maximum). The expected start date for the cohort is November 9, 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. What is A1A? 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