CVS Health

Runs pharmacies, health plans and clinics

Case Manager Registered Nurse

Medical, Clinical & VeterinaryPosted on Nov 11

Full-time

About the Job

Requirements

An active and unrestricted registered nurse license in the state of residence is required.
The candidate must be willing and able to obtain additional state licenses upon hire; the company pays for them.
At least three years of acute care and/or case-management experience is required.
At least two years of medical-surgical experience is required.
The candidate must be willing to work Monday through Friday, 8:00 a.m. to 4:30 p.m. local time.
An Associate's Degree in Nursing is required.
The candidate must have or be able to obtain a direct, hardwired internet connection to a modem or router within seven feet of the computer, with minimum speeds of 25 Mbps download and 3 Mbps upload; Wi-Fi and satellite internet are not permitted.
The candidate must have a quiet, secure, private designated home workspace compliant with company and HIPAA guidelines, free of distractions and allowing uninterrupted work during working hours.
The candidate must work within the state and city where they have confirmed they currently live.
The candidate must provide their own workspace furniture and comply with work-from-home requirements, including required internet speeds.
The candidate must be comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.
The candidate must be able to use digital communication tools, including email, calendar invitations, Teams messaging, and virtual meetings.
The candidate must have experience with Microsoft Office 365 applications, including Teams, Outlook, Word, Excel, and PowerPoint, or similar Google Workspace applications.
The candidate must be able to log in to secure systems such as a VPN or electronic health record portal, secure their computer when unattended, manage strong passwords, and recognize suspicious emails or links.
The candidate must be able to troubleshoot common technical issues independently, including restarting frozen applications and resolving internet connection issues, and contact IT for unresolved issues.
The candidate must be able to use a computer workstation and sit for extended periods.

Responsibilities

Use clinical judgment and data-driven tools to evaluate member eligibility, identify health risks, and develop proactive care plans addressing short- and long-term health outcomes.
Conduct holistic assessments considering comorbid conditions, functional limitations, and social determinants of health.
Review prior claims, evaluate work capacity, and determine the need for referrals to clinical resources.
Collaborate with supervisors and multidisciplinary teams to overcome barriers and optimize care planning.
Deliver comprehensive case-management services through telephonic and/or face-to-face interactions, including assessing, planning, implementing, and coordinating care strategies to support members' medical needs and overall wellness.
Apply case-management processes and service strategies in accordance with regulatory and organizational policies, network management, and clinical coverage guidelines.
Interview and engage members to understand their needs and facilitate transitions to appropriate programs and services.

Desired Qualifications

Behavioral health experience is preferred.
Certified Case Manager credential is preferred.
Managed-care experience is preferred.
Candidates in the Pacific time zone are preferred.
Strong telephonic communication skills are preferred.
The ability to manage multiple priorities and effective organizational and time-management skills are preferred.
Openness to learning new skills as the workplace environment evolves is preferred.

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll 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 – helping to simplify health care one person, one family and one community at a time.

Position Summary

The Nurse Case Manager is responsible for delivering comprehensive case management services through telephonic and/or face-to-face interactions. This role involves assessing, planning, implementing, and coordinating care strategies to support members' medical needs and promote overall wellness. This role operates within established regulatory and organizational policies, applying case management processes and service strategies that align with network management and clinical coverage guidelines. Strong interviewing and engagement skills are critical to understanding member needs and facilitating smooth transitions to appropriate programs and services.

What you will do

Utilize clinical judgment and data-driven tools to evaluate member eligibility, identify health risks, and develop proactive care plans that address both short- and long-term health outcomes.
Conduct holistic assessments that consider co-morbid conditions, functional limitations, and social determinants of health.
Review prior claims, evaluate work capacity, and determine the need for referrals to clinical resources.
Collaborate with supervisors and multidisciplinary teams is essential to overcome barriers and optimize care planning.

Required Qualifications

An active and unrestricted RN license in the state of residence.
Willing and able to obtain additional state licenses upon hire. (Paid for by the company)
3+ years' experience of acute care and/or case management.
2+ years' Med/Surg experience.
Must be willing to work Monday-Friday 8:00am-4:30pm local time zone.

Preferred Qualifications

Prefer candidates in PST Zone.
Behavioral Health experience.
Certified Case Manager.
Managed care experience.
Strong telephonic communication skills.
Ability to manage multiple priorities, effective organizational, and time management skills.
Ability use a computer station and sit for extended periods of time.

Education and Licensing

Associate's Degree in Nursing.
RN License in your state of residence.

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 Mbps download and 3 Mbps 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

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,095.00 - $116,760.00

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 11/18/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

About the Company

CVS Health

Runs pharmacies, health plans and clinics

CVS Health runs pharmacies, health insurance plans and medical clinics for individuals, employers and government programs across the United States. Its businesses include CVS Pharmacy, the Aetna insurer and Caremark, which manages prescription coverage and negotiates drug prices for health plans. Patients fill prescriptions in stores or by mail and receive care through walk-in clinics, primary care centers and home visits. The company earns money from prescription sales, insurance premiums, plan administration fees and clinical services, combining coverage with places to obtain treatment. Its first store opened in 1963, and its headquarters are in Woonsocket, Rhode Island.

Company size: 10,001+
Company stage: IPO
Headquarters: Woonsocket, Rhode Island
Founded: 1963

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