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CVS Health Case Manager RN in San Antonio, Texas

Job Description

This role is fully remote. Candidates should reside within acommutable distance to San Antonio, TX. Travel to theSan Antonio office occasionally will be required onceCOVID restrictions are lifted.Standard business hours are required Monday-Friday withflexibility to rotate to 7pm CST on occasion.Nurse Case Manager is responsible for telephonicallyand/or face to face assessing, planning, implementing andcoordinating all case management activities with membersto evaluate the medical needs of the member to facilitatethe member’s overall wellness. Develops a proactivecourse of action to address issues presented to enhancethe short and longterm outcomes as well as opportunitiesto enhance a member’s overall wellness throughintegration. Services strategies policies and programs arecomprised of network management and clinical coveragepolicies.- Through the use of clinical tools and information/datareview, conducts an evaluation of member's needs andbenefit plan eligibility and facilitates integrative functions aswell as smooth transition to Aetna programs and plans.- Applies clinical judgment to the incorporation ofstrategies designed to reduce risk factors and barriers andaddress complex health and social indicators which impactcare planning and resolution of member issues.- Assessments take into account information from varioussources to address all conditions including co-morbid andmultiple diagnoses that impact functionality.- Reviews prior claims to address potential impact oncurrent case management and eligibility.- Assessments include the member’s level of work capacityand related restrictions/limitations.- Using a holistic approach assess the need for a referralto clinical resources for assistance in determiningfunctionality.- Consults with supervisor and others in overcomingbarriers in meeting goals and objectives,presents cases at case conferences for multidisciplinaryfocus to benefit overall claim management.- Utilizes case management processes in compliance withregulatory andcompany policies and procedures.- Utilizes interviewing skills to ensure maximum memberengagement and discern their health status and healthneeds based on key questions and conversation.

Required Qualifications

  • RN with current unrestricted state licensure required- Willing and able to obtain additional state licenses upon hire- 3+ years clinical practice experience

COVID Requirements

COVID-19 Vaccination Requirement

CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, pregnancy, or religious belief that prevents them from being vaccinated.

  • If you are vaccinated, you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

  • If you are unable to be fully vaccinated due to disability, medical condition, pregnancy, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

  • Case Management experience - Bilingual preferred


  • RN with current unrestricted state licensure required

Business Overview

At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.