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Position Summary This position will be serving the Northern Virginia area. Qualified candidates must live in Reston, Fairfax County or surrounding areas. Monday‑Friday standard business hours.
Roles and Responsibilities Nurse 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 the member's overall wellness. The role develops a proactive course of action to address issues presented to enhance short‑ and long‑term outcomes and opportunities to enhance a member's overall wellness through integration. Services, strategies, policies and programs are comprised of network management and clinical coverage policies.
Through the use of clinical tools and information/data review, the candidate 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. The nurse applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators that impact care planning and resolution of member issues. Assessments take into account information from various sources to address all conditions including co‑morbidity and multiple diagnoses that impact functionality. Prior claims are reviewed to address potential impact on current case management and eligibility. Assessments include the member's level of work capacity and related restrictions/limitations. Using a holistic approach the nurse assesses the need for a referral to clinical resources for assistance in determining functionality. The nurse consults with supervisor and others to overcome barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. The candidate utilizes case management processes in compliance with regulatory and company policies and procedures. Interviewing skills are used to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
Required Qualifications RN with current unrestricted Virginia state licensure required
3+ years clinical experience as a Registered Nurse (e.g., med‑surg, behavioral health, acute care)
Must reside in Reston, Virginia or surrounding areas
Must be willing and able to travel up to 75% of the time to meet members in their home
Preferred Qualifications Case Management in an integrated model preferred
Bilingual in English/Spanish preferred
Ability to multitask, prioritize and effectively adapt to a fast‑paced changing environment
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Effective communication skills, both verbal and written
Education Associate degree in Nursing required
Bachelor's degree preferred
Unrestricted Virginia State RN License required
Anticipated Weekly Hours 40
Time Type Full time
Pay Range The typical pay range for this role is: $60,522.00 - $129,615.00. 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:
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/benefits
We anticipate the application window for this opening will close on: 11/24/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.