Job Title

Weu2019re building a world of health around every individual u2014 shaping a more connected, convenient and compassionate health experience. At CVS Healthu00ae, youu2019ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger u2013 helping to simplify health care one person, one family and one community at a time. Program Overview Help us elevate patient care to a whole new level. Join the Aetna Clinical Collaboration (ACC) team - an innovative and growing, communityu2011based care management model designed to transform how we serve our members. ACC utilizes bestu2011inu2011class clinical and operating models to deliver meaningful, highu2011impact care where it matters most. ACC is a memberu2011centric, teamu2011delivered approach that meets members where they are. Through compassionate engagement and strong communication, our care teams collaborate with members, providers, and community organizations to address the full continuum of healthcare needs, including medical, behavioral, and social determinants of health. This is an exciting opportunity to be part of a growing program with national expansion, offering the chance to help shape care delivery in new markets and have a lifeu2011changing impact on the members we serve. Family Summary/Mission This role supports the delivery of appropriate benefits and healthcare services by facilitating eligibility determination, promoting wellness activities, and advancing successful, timely health outcomes. The team develops, implements, and supports health strategies, policies, and programs that ensure effective care delivery and overall member wellness. Services span network management, clinical coverage, and evidenceu2011based policies. Position Summary/Mission The ACC Case Manager applies a collaborative, memberu2011centered approach to assessment, care planning, coordination, evaluation, and advocacy to address the comprehensive health needs of individuals and families. This is an onu2011site, hospitalu2011based role supporting members receiving care at Swedish American Hospital and requires consistent inu2011person engagement with members, providers, and multidisciplinary care teams. Candidates must reside within reasonable driving distance of the facility to support reliable onu2011site presence and timely care coordination. Fundamental Components & Physical Requirements + Serve as a liaison between members/clients, families, employers, providers, insurance carriers, and healthcare personnel as appropriate. + Implement and coordinate case management activities for catastrophic and chronically ill members across the continuum of care, including consultant referrals, home care, community resources, and alternative levels of care. + Interact with members/clients both telephonically and in person while working onu2011site at Swedish American Hospital , including meeting with members during inpatient admissions. + Assess medical, functional, and vocational status to develop and implement individualized plans of care that support optimal health outcomes, benefits eligibility, and timely return to work or baseline functioning. + Communicate effectively with stakeholders including medical providers, attorneys, employers, and insurance carriers. + Prepare timely and accurate documentation of all case management activities. + Collaborate with internal multidisciplinary teams to support optimal member outcomes. + Conduct outreach to treating physicians and specialists to support appropriate care planning. + Provide education and preventive guidance to promote best clinical outcomes. + Apply applicable laws, regulations, and payer requirements related to rehabilitation and case management services. + Monitor member progress toward desired outcomes and adjust care plans as needed. + Develop proactive strategies to address complex needs and support both shortu2011 and longu2011term wellness outcomes. This role is eligible for a $10,000 New Hire Bonus Required Qualifications + Candidate must have active and unrestricted Illinois Registered Nurse (RN) License + 3+ years of clinical experience, preferably with Medicare and Commercial populations + Ability to work independently within a hospitalu2011based environment + Strong analytical, problemu2011solving, organizational, and communication skills + Proficiency in MS Word, Excel, Outlook, PowerPoint, and proprietary clinical systems + Efficient computer skills, including navigating multiple systems and keyboarding + Reliable transportation and the ability to consistently meet onu2011site, hospitalu2011based work requirements at Swedish American Hospital Preferred Qualifications + 1+ year(s) of experience in care management, discharge planning, or home health coordination + Willingness to obtain multiu2011state RN licensure (company supported) + National certification (CRC, CDMS, CRRN, COHN, or CCM) Education + Associateu2019s Degree in Nursing with equivalent clinical experience (REQUIRED) + Bachelor's Degree in Nursing (PREFERRED) License + Active and unrestricted Illinois Registered Nurse (RN) License Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $66,575.00 - $142,576.00 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. Our 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. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits u2013 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: + 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. For more information, visit We anticipate the application window for this opening will close on: 03/02/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran u2014 committed to diversity in the workplace.