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. Position Summary Help us elevate our patient care to a whole new level Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our membersu2019 health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country. Family Summary/Mission Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements, and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies. Position Summary/Mission Our Case Managers use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individualu2019s and familyu2019s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes. Fundamental Components & Physical Requirements + Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. + Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. + Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physicianu2019s office to provide ongoing case management services. + Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/clientu2019s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate. + Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person. + Prepares all required documentation of case work activities as appropriate. + Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes. + May make outreach to treating physician or specialists concerning course of care and treatment as appropriate. + Provides educational and prevention information for best medical outcomes. + Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources. + Conducts an evaluation of members/clientsu2019 needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data. + Utilizes case management processes in compliance with regulatory and company policies and procedures. + Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work. + 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 memberu2019s/clientu2019s overall wellness through integration. + Monitors member/client progress toward desired outcomes through assessment andevaluation. Required Qualifications + Candidate must reside in Winnebago, Stephenson, Boone County IL or surrounding counties + Ability to travel up to 50-75% of the time within a designated geographic area for in-person case management activities as directed by leadership and/or as business needs arise + Candidate must have active and unrestricted Illinois Registered Nurse (RN) License + 3-5 years clinical practical experience + 2-3 years care management, discharge planning and/or home health care coordination experience + Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually + Excellent analytical and problem-solving skills + Effective communications, organizational, and interpersonal skills + Ability to work independently + Proficiency with standard corporate software applications, including Microsoft Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications + Efficient and effective computer skills including navigating multiple systems and keyboarding Preferred Qualifications + Certified Case Manager Education + Associate's Degree in Nursing (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: 04/06/2026 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.