Case Manager Registered Nurse - Field - Must reside near Reston Virginia

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.\n\nAs 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. And we do it all with heart, each and every day.\n\nPosition Summary\n\nThis position will be serving the Northern Virginia area. Qualified candidates must live in Reston - Fairfax County or Surrounding Areas.\n\nMonday-Friday Standard Business Hours.\n\nRoles And Responsibilities\n\nNurse 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. 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. Services strategies policies and programs are comprised of network management and clinical coverage policies.\n\nThrough 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\n\nindicators which impact care planning and resolution of member issues. Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Reviews prior claims 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 assess the need for a referral to clinical resources for assistance in determining functionality. Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.\n\nRequired Qualifications\n

• RN with current unrestricted Virginia state licensure required\n
• 3+ years clinical experience as a Registered Nurse (i.e. med surg, behavioral health, acute care)\n
• Must reside in Reston Virginia or Surrounding Areas\n
• Must be willing and able to travel up to 75% of the time to meet members in their home\n\nPreferred Qualifications\n
• Case Management in an integrated model preferred\n
• Bilingual in English / Spanish preferred\n
• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment\n
• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.\n
• Effective communication skills, both verbal and written.\n\nEducation\n
• Associate degree in Nursing required\n
• Bachelor's degree preferred\n
• Unrestricted Virginia State RN License required.\n\nAnticipated Weekly Hours\n\n40\n\nTime Type\n\nFull time\n\nPay Range\n\nThe Typical Pay Range For This Role Is\n\n$60,522.00 - $129,615.00\n\nThis 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.\n\nOur people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.\n\nGreat Benefits For Great People\n\nWe 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 : \n
• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.\n
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.\n
• 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.\n\nFor more information, visit https : / / jobs.cvshealth.com / us / en / benefits\n\nWe anticipate the application window for this opening will close on : 11 / 24 / 2025\n\nQualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.