Care Management Manager Jobs

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. *Must reside in the state of Illinois* 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. Position Summary The Case Management Registered Nurse utilizes critical thinking and judgment to collaborate and inform the case management process. The Case Management nurse facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources Required Qualifications • Must reside in the state of Illinois •Must possess reliable transportation and be willing and able to travel up to 75% of the time from home location in and around Metro

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. 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. Position Summary The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process. The Case Management Coordinator facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources Required Qualifications • Must reside in the state of Illinois •Must possess reliable transportation and be willing and able to travel up to 75% of the time from home location in and around Central Illinois(Peoria, Tazewell, Knox, Stark, Fulton, Woodford, Mar

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. 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. Position Summary The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process. The Case Management Coordinator facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources Required Qualifications • Must reside in the state of Illinois •Must possess reliable transportation and be willing and able to travel up to 50-75% of the time from home location in and around East Central Illinois (Champaign, Vermilion, Ford, Piatt, Douglas,

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. 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. Position Summary The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process. The Case Management Coordinator facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits and education for members through the use of care management tools and resources Required Qualifications • Must reside in the state of Illinois •Must possess reliable transportation and be willing and able to travel up to 50-75% of the time from home location in and around North/Northwest Suburbs of Chicago. Mileage is reimbursed per our

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. Schedule: Monday-Friday 8AM - 5PM Travel: Up to 55-75% travel in and around Yale New Haven, CT. Position Summary Program Overview Help us elevate our patient care to a whole new level! Join our Community Care team as an industry leader in serving our members by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Community Care members. Community Care is a member centric, team-delivered, community-based care management model that joins members where they are. 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. Family 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 strateg

Become a part of our caring community As a RN Care Manager, you will enjoy a true work-life balance with no night or weekend shifts. Reporting to the Manager of Care Coaching, you will support members enrolled in the Wisconsin Family Care Program providing essential care coordination, support, and education. You will make a difference in the lives of those you serve and within your own community. You will support members in any of the following counties- Lincoln, Langlade, Forest, Oneida, Vilas You will: Assess members, focusing on health and safety needs, to develop a comprehensive Member Care Plan (MCP). Conduct regular health assessments Coordinate with acute and primary care providers. Educate members on disease processes and related risks, nutrition, exercise and lifestyle modifications to support informed decision-making while respecting each person's autonomy. Document in member files within required DHS contract timeframes. Participate in member monthly phone contacts and travel to attend in person visits in members setting. Work remotely from your home and travel approximately 40% of the time to visit your members. Use your skills to make an impact Required Qualifications Associate degree in nursing Licensed Registered Nurse in the state of Wisconsin (in good standing) Preferred Qualifications 1 year Care Management experience Reside within 45 mins or less of the assigned coverage area Previous Care Management experience Additional Information Location: any of the following counties: Lincoln, Langlade, Oneida, Forest, Vilas Travel: Up to 40% Typical Workdays/Hours: Monday through Friday, 8:00 am – 4:30 pm CST.

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 – Case Manager Analyst - Field Location: Will & DuPage Counties, IL Must reside in one of the following Zip Codes: 60606, 60607, 60608, 60609, 60610, 60611, 60612, 60614, 60622, 60623, 60624, 60632, 60639, 60644, 60647, 60651, 60653 This Case Management Analyst Field position is with Aetna’s Long-Term Services & Supports (LTSS) team and is a field-based position. The requirement is for candidates to travel up to 75% of the time to meet with members face to face. This position holds a full caseload to manage waiver members. This position requires in person quarterly visits with members. This position is critical to meeting contractual requirements. Facilitate appropriate healthcare outcomes for waiver/LTSS members by providing care coordination, support and education for members through the use of care management tools and resources. Evaluation of Members: Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral

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 – Case Manager Analyst - Field Location: Champaign, IL This Case Management Analyst Field position is with Aetna’s Long-Term Services & Supports (LTSS) team. The requirement is for candidates to travel 75% of the time to meet with members face to face. This position holds a full caseload to manage waiver members. This position requires in person quarterly visits with members. This position is critical to meeting contractual requirements. Facilitate appropriate healthcare outcomes for waiver/LTSS members by providing care coordination, support and education for members through the use of care management tools and resources. Evaluation of Members: Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate. Coordinates and implements assigned care plan activities and monitors care plan progress. Enhancement of Medical Appropriateness and Quality of Care: Using holistic approach consults with case man

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 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 Aetna Medical Economics Unit (MEU) has an exciting opportunity for a Senior Informatics Manager to join our Performance Guarantee and Operational Reporting Team. The Operational Reporting and Analytics team within MEU is responsible for operational measurement and analysis for all Care Management programs. The role is responsible for ensuring the accuracy, consistency, and integrity of measure specifications, validation processes, and reporting outputs that support clinical performance guarantee reporting. The Senior Informatics Manager will serve as a key liaison across business, clinical, underwriting, reporting, and technology teams to drive alignment on measure logic, data requirements, validation findings, and implementation strategies. Furthermore, this role will support efforts to drive continuous improvement. Responsibilities Develop and maintain clinical performance report logic/code and report production Compile detailed reporting requirements, understand clinical programs and workflows as well as data sources. Track progress against performance targets. Evaluate outcomes and communicate progress to stakeholders. Collaboration with Underwriting and Business Stakeholders. Required Qualifications 7+ years of experience in reporting and analytics with advanced SQL development, data mo

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 Aetna Medical Economics Unit (MEU) has an exciting opportunity for a Senior Informatics Manager – QuickBase Developer to join our Performance Guarantee and Operational Reporting Team. The Operational Reporting and Analytics team within MEU is responsible for operational measurement and analysis for all Care Management programs. You will act as the analytic lead for complex projects involving multiple resources and tasks while providing support for business objectives. The role is responsible for ensuring the accuracy, consistency, and integrity of measured specifications, validation processes, and reporting outputs that support clinical performance guarantee reporting with focus on building out PG QuickBase strategy for tracking non-compliant review process. Furthermore, this role will support efforts to drive continuous improvement. Responsibilties Develop and maintain QuickBase applications Develop and maintain clinical performance report logic/code and report production Compile detailed reporting requirements, understand clinical programs and workflows as well as data sources. Track progress against performance targets. Collaboration with Underwriting and Business Stakeholders. Required Qualifications 7+ years of experience in reporting and analytics with advanced SQL development, data m

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 As a Case Management Coordinator you will facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources. Travel: 50-75% travel required within Lake County, IL. Evaluation of Members: Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services. Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate. Coordinates and implements assigned care plan activities and monitors care plan progress. Enhancement of Medical Appropriateness and Quality of Care: Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes. Identifies and escalates quality of care issues through established channels. - Utilizes negotiation sk

Become a part of our caring community Great nursing careers should leave room for your life, too! You will enjoy no nights or weekends while making a meaningful difference for Wisconsin Family Care Program members in your community. Reporting to the Manager of Care Coaching, you will coordinate care, provide support and education, and help members navigate their care with confidence. You will: Assess members, focusing on health and safety needs, to develop a comprehensive Member Care Plan (MCP). Conduct regular health assessments Coordinate with acute and primary care providers. Educate members on disease processes and related risks, nutrition, exercise and lifestyle modifications to support informed decision-making while respecting each person's autonomy. Document in member files within required DHS contract timeframes. Participate in member monthly phone contacts and travel to attend in person visits in members setting. Work remotely from your home and travel approximately 40% of the time to visit your members. Use your skills to make an impact Required Qualifications Associate degree in nursing Licensed Registered Nurse in the state of Wisconsin (in good standing) Preferred Qualifications 1 year Care Management experience Reside within 45 mins or less of the assigned coverage area Previous Care Management experience Additional Information Location: Milwaukee, WI Travel: Up to 40% Typical Workdays/Hours: Monday through Friday, 8:00 am – 4:30 pm CST. Driving This role is part of Humana's driver safety program and therefore requires an individual to have a valid state drive

Become a part of our caring community Discover a rewarding opportunity to make a meaningful difference as a Care Coach with Humana Gold Plus-Integrated in Illinois. In this vital role, you will be at the forefront of supporting members' health and wellness by conducting comprehensive assessments, identifying needs, and guiding members and their families to essential resources for optimal care. You will report to the Manager, Care Management and join a dedicated team where your expertise helps break down barriers to effective healthcare, empowers individuals to achieve their best outcomes, and strengthens our commitment to delivering compassionate, patient-centered service. Take the next step in your healthcare career and help shape positive change in the lives of those we serve. Employs a variety of strategies, approaches and techniques to manage a member's health issues telephonically. Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through use of assessments, data, conversations with member, and active care planning. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation. Follows established guidelines/procedures. Use your skills to make an impact Required Qualifications Bachelor's degree in a health-related field, active Illinois LPN licensure, or the ability to obtain IL LPN license. 2 or more years of case management, medical case management, care coordination, or healthcare su