Case Manager Registered Nurse - Field (Southwest Michigan)
At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose‑driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate.
Position Summary – Help us elevate our patient care to a whole new level!
This role will involve 25‑50% travel within Southwest Michigan (Barry, Van Buren, Kalamazoo, Calhoun, Branch, St. Joseph, Cass, and Berrien Counties). The position is work‑from‑home.
Schedule : Standard business hours 8:00 AM‑5:00 PM, no night, weekend or holiday shifts. Opportunities to work a 4‑day 10‑hour work week after completion of training.
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.
Responsibilities
Visiting members in their homes to evaluate appropriateness for waiver services, writing the waiver and submitting for approval.
Developing a proactive plan of care to address identified issues to enhance short and long‑term outcomes and overall wellness.
Using clinical tools and data review to conduct an evaluation of member needs and benefits.
Applying clinical judgment to incorporate strategies designed to reduce risk factors, barriers, and complex health and social indicators that impact care planning.
Conducting assessments that consider information from various sources, such as claims, to address all conditions including comorbidities and multiple diagnoses that impact functionality.
Using a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members.
Collaborating with supervisors and other key stakeholders in the member’s health care to overcome barriers in meeting goals and objectives; presenting cases at interdisciplinary case conferences.
Utilizing case‑management processes in compliance with regulatory and company policies and procedures.
Using motivational interviewing skills to ensure maximum member engagement and discern their health status and needs based on key questions and conversation.
Required Qualifications
Registered Nurse with an active MI state license in good standing.
Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually.
Ability to travel within a designated geographic area for in‑person case‑management activities as directed by leadership and/or as business needs arise.
Excellent analytical and problem‑solving skills.
Effective communications, organizational, and interpersonal skills.
Ability to work independently.
Effective computer skills, including navigating multiple systems and keyboarding.
Proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint.
Preferred Qualifications
Care Management, discharge planning and/or home health care coordination experience.
Certified Case Manager.
Education
Associate’s required, BSN preferred.
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient‑focused.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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
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.
We anticipate the application window for this opening will close on: 12/31/2025.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.