Case Manager, Registered Nurse - Fully Remote

📋 Description

• • This remote Case Manager, Registered Nurse role at CVS Health Corporation’s American Health Holding division supports members across multiple states by providing telephonic case management for fully and/or self-insured clients, ensuring appropriate care coordination and benefit administration.
• • Day to day, the nurse will conduct assessments using clinical guidelines, apply clinical judgment to reduce risk factors, consult with multidisciplinary teams, utilize motivational interviewing to engage members, perform medical necessity reviews, and escalate needs per protocol while documenting electronically and collaborating with care teams.
• • The team operates within a URAC-accredited medical management division of Aetna/CVS Health, focused on delivering cost-effective, quality care through flexible medical management services for members nationwide.
• • In this role, the nurse can deepen expertise in case management, gain experience with specialty populations (e.g., Oncology, Transplant, Behavioral Health), pursue certifications like CCM, and develop leadership and communication skills in a nationally recognized healthcare organization committed to innovation and compassionate care.