Program Overview

Help us elevate patient care to a whole new level. Join Aetna, an industry leader in serving dual-eligible populations through best-in-class clinical and operational models. In this role, you will have a meaningful impact on members enrolled in both Medicare and Medicaid who face complex medical, behavioral, and social challenges.

Through compassionate support and effective communication, we partner with members, providers, caregivers, and community organizations to address the full spectrum of healthcare and social determinant needs. As we continue to grow and expand into new markets across the country, we invite you to join us in transforming lives and improving health outcomes.

Position Summary

The Care Manager RN uses a collaborative, member-centered approach to assess, plan, coordinate, implement, monitor, and evaluate healthcare services. This role partners with members and their families to address comprehensive health needs, facilitate access to appropriate resources, and promote quality, cost-effective outcomes.

The Care Manager develops and implements individualized care plans that support wellness, optimize clinical outcomes, and ensure members receive the appropriate benefits, services, and support needed to achieve their health goals.

Key Responsibilities

• Serve as a liaison among members, families, providers, employers, health plans, community organizations, and other key stakeholders.
• Coordinate and manage care activities for members with complex, chronic, catastrophic, or acute health conditions across the continuum of care.
• Conduct comprehensive assessments to evaluate medical, functional, psychosocial, and environmental needs.
• Develop, implement, and monitor individualized care plans designed to improve health outcomes and support member wellness.
• Facilitate access to appropriate healthcare services, community resources, home health services, and alternative levels of care.
• Engage with members telephonically and through in-person visits in homes, provider offices, or community settings as needed.
• Collaborate with interdisciplinary care teams to ensure coordinated, evidence-based care.
• Communicate effectively with providers, members, caregivers, and other stakeholders regarding treatment plans, progress, and care needs.
• Educate members and families on disease management, prevention strategies, available benefits, and community resources.
• Conduct outreach to treating physicians, specialists, and other providers to support care coordination and treatment planning.
• Monitor member progress and adjust care plans as needed to achieve desired outcomes.
• Maintain accurate and timely documentation of case management activities in accordance with organizational, regulatory, and accreditation requirements.
• Ensure compliance with all applicable laws, regulations, policies, and case management standards.
• Promote optimal health outcomes, functional independence, and quality of life through proactive intervention and advocacy.

Required Qualifications

• Active and unrestricted Registered Nurse (RN) license in IL
• Must possess reliable transportation and be willing and able to travel up to 50-75% of the time in Kane county and surrounding areas. Mileage is reimbursed per our company expense reimbursement policy
• Minimum of 3-5 years of clinical nursing experience.
• Minimum of 2-3 years of experience in case management, discharge planning, care coordination, or home health.
• Strong clinical assessment, critical thinking, and problem-solving skills.
• Excellent communication, organizational, and interpersonal skills.
• Ability to work independently and effectively in a remote environment.
• Comfortable use of technology to collaborate virtually with interdisciplinary teams.
• Proficiency in Microsoft Office applications, including Word, Excel, Outlook, and PowerPoint, as well as care management and documentation systems.
• Strong computer skills with the ability to navigate multiple systems simultaneously.

Preferred Qualifications

• Certified Case Manager (CCM) certification.
• Experience working with Medicare, Medicaid, or dual-eligible populations.
• Experience in addressing social determinants of health and coordinating community-based services.

Education

• Associate or bachelor's degree in nursing from an accredited institution.

Work from Home Requirements

• You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted. • A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours. • Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live. • The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time). • If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical and Logistical Requirements

• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency. • Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings. • Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace). • Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links. • Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues. • Future Growth: Openness to learning new skills in the future as the workplace environment evolves

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is

$66,575.00 - $142,576.00