Case Manager, Registered Nurse - Fully Remote

American Health Holding (a division of Aetna/CVS Health) is hiring a fully remote telephonic RN Case Manager. You'll work intensely with patients and their care teams for fully and/or self-insured clients, applying clinical guidelines, standardized care management plans, and regulatory standards to assess benefits and member needs.

Using a holistic approach, you'll apply clinical judgment to reduce risk factors and address complex health and social indicators impacting care planning. Assessments incorporate information from multiple sources to address co-morbid and multiple diagnoses. You'll consult with supervisors, Medical Directors, and clinical colleagues to overcome barriers, present cases at multidisciplinary case conferences, and use motivational interviewing to maximize member engagement. The role also includes performing medical necessity reviews and proactively reaching out to members to guide their care.

Requirements: 5+ years RN experience with at least 1 year in a hospital setting; experience in Oncology, Transplant, Specialty Pharmacy, Pediatrics, Med/Surg, Behavioral Health/Substance Abuse, or Maternity/OB; comfort with electronic documentation. Compact-state nurses need an active multistate NLC license; non-compact-state nurses need individual state licenses for each state they support. ADN required, BSN preferred. Preferred: case management or discharge planning experience, UR experience, CCM, MCG/NCCN/Lexicomp familiarity, Spanish bilingual.

Salary range: $54,095–$155,538 depending on experience, education, and geography.