Case Management Associate 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. Position Summary This is a full-time field teleworker position that requires West Virginia residency. Travel is required 50% of the time or more, in the central region of WV. Field based travel locations may include member homes, residential treatment facilities, group homes, shelters, and detention facilities. Qualified candidates must reside in the region, in one of the following counties: Braxton, Calhoun, Clay, Fayette, Gilmer, Kanawha, Nicholas, Roane, Webster-Regional . Utilizes critical thinking and judgment to collaborate and inform the case management process, to facilitate appropriate healthcare outcomes for members by providing care coordination, support, and education for members through the use of care management tools and resources. Schedule is Monday-Friday standard business hours. No nights, no weekends, and no holidays. 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. - Co

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. Business Overview: The Aetna Better Health of West Virginia plan has a successful, 26+ year history of partnering with the State to provide West Virginia’s Medicaid population with top notch health care coordination and service. The plan also has been chosen to provide care coordination to complex foster care children of the state. Through a strong, localized team, an innovative care management model, and creative provider and community advocacy partnerships, Aetna Better Health of West Virginia has successfully assisted the State in achieving high quality standards and outcomes for the Medicaid population across the state. The health plan truly embodies the commitment of West Virginian’s helping West Virginian’s. At Aetna Better Health of West Virginia, you can be the very best you can be working with strong teams committed to helping our members and with opportunities for career growth. We will support you all the way! Position Summary: This is a full-time field teleworker position that requires West Virginia residency. Travel is required 50% of the time or more, in the Northern region of WV. Field based travel locations may include member homes, residential treatment facilities, group homes, shelters, and detention facilities. Qualified candidates must reside in the region, in one of the following counties: Barbour, Brooke, Doddridge, Hancock, Harrison, Lewis, Marion,

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. *New Hire Bonus - $3,000 Available!* Location: This is a full-time telework position requiring 50-75% travel in and around Metro east/Southern Illinois Schedule: Standard business hours Monday-Friday 8:00am-5:00pm CST. 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. Key Responsibilities Evaluation of Members: Through the use of care management tools and information/data review, conducts comprehensive evaluation of 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 a

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. *$3,000 New Hire Bonus Available!* Location: This is a full-time telework position requiring 50-75% travel in and around Northwest Il including Winnebago, Boone, Stephenson, Ogle, Jo Daviess. Schedule: Standard business hours Monday-Friday 8:00am-5:00pm CST. 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. Key Responsibilities Evaluation of Members: Through the use of care management tools and information/data review, conducts comprehensive evaluation of 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 Appropriatenes

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. Remote RN Case Manager (Case Management & Utilization Management) Aetna National Medical Excellence (NME) is seeking an experienced Registered Nurse (RN) Case Manager to join our growing team. This is a fully remote opportunity open to candidates nationwide, with preference given to nurses residing in compact licensure states . In this blended role, you will combine Case Management and Utilization Management expertise to support members with complex healthcare needs. You'll partner with members, providers, and interdisciplinary teams to develop personalized care plans, improve health outcomes, reduce barriers to care, and promote overall wellness. What You'll Do Assess, coordinate, and manage care for members with complex medical needs Develop proactive care plans to improve short- and long-term health outcomes Identify clinical, social, and functional barriers impacting care Collaborate with healthcare providers and multidisciplinary teams Utilize clinical judgment to support effective utilization and care management decisions Engage members through telephonic care management and health coaching Required Qualifications Active, unrestricted Compact RN license in state of residence 5+ years of RN clinical practice experience 2+

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. Remote RN Case Manager 100% Remote | Nationwide Opportunity | Monday–Friday Schedule Are you a Registered Nurse passionate about helping members navigate complex healthcare needs? Join our Case Management team and make a meaningful impact by guiding members toward better health outcomes through personalized care planning, advocacy, and coordination. What You'll Do Conduct telephonic assessments to evaluate members' medical, behavioral, and social needs Develop individualized care plans that support improved health outcomes and overall wellness Identify barriers to care and implement strategies to reduce risk and improve member engagement Coordinate care across providers, programs, and community resources Review clinical information, claims history, and benefit eligibility to support appropriate interventions Utilize motivational interviewing and clinical judgment to engage members and support goal achievement Collaborate with multidisciplinary teams to address complex cases and facilitate optimal outcomes Ensure compliance with regulatory requirements and company case management standards WHAT YOU BRING - REQUIRED Active, unrestricted RN licens

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. This RN Case Manager position is 100% remote and candidates can apply from any state but must work the stated hours. There is a preference for nurses in a compact RN licensure state, however, that is not required. Normal Working Hours: Monday through Friday between the hours of 8:30am – 5:00pm in their time zone for a scheduled 8-hour shift. Weekends and holidays may be required per the needs of the department. Currently, both weekends and holidays are on-call only and covered on a volunteer basis. Less than 5% travel may be required for on-site meetings, trainings, or system updates, or to meet licensure requirements e.g., finger printing. 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 overall wellness. RN Case Manager: – Collaboratively develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as

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 Normal Working Hours: Monday-Friday 8:00am - 4:30 pm in your local time zone There are no weekend hours. There are no holiday coverage hours. There is no travel. This is a 100% remote work from home position and candidates from any state with a compact RN license can apply. This position is for a NICU/ High-Risk Maternity case management team and experience with this is required. The Case Manager RN 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 within a NICU/ high-risk maternity case management program. The Case Manager RN is empowered to take care of all aspects of a member's NICU and/ or maternity journey. The Case Manager RN 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. The Case Manager RN includes some of the following roles (not all inclusive): -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

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 position is 100% remote and candidates can apply from any state but must work the stated hours. There is a preference for nurses in a compact RN licensure state, however, that is not required. Normal Working Hours: Monday through Friday between the hours of 8:30am – 5:00pm in their time zone for a scheduled 8-hour shift. Weekends and holidays may be required per the needs of the department. Currently, both weekends and holidays are on-call only and covered on a volunteer basis. Less than 5% travel may be required for on-site meetings, trainings, or system updates, or to meet licensure requirements e.g., finger printing. 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 overall wellness. RN Case Manager: – Collaboratively develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as

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 position is 100% remote and candidates can apply from any state but must work the stated hours. There is a preference for nurses in a compact RN licensure state, however, that is not required. Normal Working Hours: Monday through Friday between the hours of 8:30am – 5:00pm in their time zone for a scheduled 8-hour shift. Weekends and holidays may be required per the needs of the department. Currently, both weekends and holidays are on-call only and covered on a volunteer basis. Less than 5% travel may be required for on-site meetings, trainings, or system updates, or to meet licensure requirements e.g., finger printing. 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 overall wellness. RN Case Manager: – Collaboratively develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as

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. 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 strategies, policies and programs are comprised of network management, clinical coverage, and policies. Position Summary/Mission 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. 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 p

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: The Case Manager RN role is telework and must be located in North Carolina. Normal Working Hours: Monday through Friday 9:00am – 5:30pm EST. Occasional evening, and holiday shifts per the needs of the team. 0-10% travel possible including but not limited to travel to the High Point office for customer meetings if you reside within 30 miles. The RN Case Manager is responsible for telephonically 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. RN Case Manager: 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 take into account information from various sources to

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: The Complex Nurse Case Manager is responsible for assessing members through regular and consistent in person or telephonic contact to assess, plan, implement and coordinate all case management activities with members to evaluate the medical and psychosocial needs of the member to facilitate and support the member’s improved health. The Case Manager 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. Services strategies policies and programs are comprised of network management and clinical coverage policies. This is a field-based position that requires routine regional in-state travel 80-90% of the time; use of personal vehicle is required. Qualified candidates must have valid KY driver's license, proof of vehicle insurance, and reliable transportation. Travel to the Louisville office is also anticipated for meetings and training. This position is assigned to the Two Rivers Region. Qualified candidates must reside in one of the counties within Two Rivers (Union, Webster, Henderson, Daviess, Hancock, McLean, Ohio, Butler, Edmonson, Hart, Warren, Logan, Simpson, Allen, Monroe, Metcalfe, Barren). Evaluation of Members: Through the use of clinical assessment tools and evaluating information/data review, conducts a comprehensi