Complex Nurse Case Manager – Field

CVS Health

Complex Nurse Case Manager responsible for evaluating medical and psychosocial needs of members. Field-based role requiring travel in Kentucky to assist members with their health care plans.

Posted 6/17/2026full-timePrinceton • Kentucky • 🇺🇸 United StatesMid-LevelSenior💰 $54,095 - $116,760 per yearWebsite

About the role

Key responsibilities & impact

The Complex Nurse Case Manager is responsible for assessing members through regular and consistent in person or telephonic contact to assess, plan, implement and coordinate all case management activities with members to evaluate the medical and psychosocial needs of the member to facilitate and support the member’s improved health.
The Case Manager 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 member’s overall wellness.
Services strategies policies and programs are comprised of network management and clinical coverage policies.
This is a field-based position that requires routine regional in-state travel 80-90% of the time; use of personal vehicle is required.
Evaluation of Members: Through the use of clinical assessment tools and evaluating information/data review, conducts a comprehensive and holistic evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
Integrates assessment data from all care partners to holistically address all physical and behavioral health conditions including co-morbid and multiple diagnoses that impact functionality and member well-being.
Creates, monitors and revise member care plans to comprehensively address member biopsychosocial care needs.
Reviews prior claims to address potential impact on current case management and eligibility.
Consults with supervisor and other care partners to overcome barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
Utilizes case management processes in compliance with regulatory and company policies and procedures.
Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
Helps member actively and knowledgably participate with their provider in healthcare decision-making.
Field-based working environment with productivity and quality expectations.

Requirements

What you’ll need

5+ years’ clinical practice experience
RN with current unrestricted state licensure required
Experience or detailed knowledge of the Foster Care and juvenile justice systems, Adoption Assistance, the delivery of Behavioral Health Services, Trauma-informed Care, ACEs, Crisis Intervention services, and evidence-based practices applicable to the Kentucky SKY populations, is required.
Flexibility to work beyond core business hours of Monday-Friday, 8am-5pm, is required
Reliable transportation required
Must reside within The Lakes Region: Fulton, Hickman, Carlisle, Ballard, Graves, McCracken, Marshall, Calloway, Livingston, Crittenden, Lyon, Trigg, Caldwell, Hopkins, Christian, Muhlenberg and Todd Counties.

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
other resources, based on eligibility

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical assessmentcase managementcare planningmotivational interviewingrisk factor reductiondata evaluationbiopsychosocial assessmentCrisis Interventionevidence-based practicestrauma-informed care

Soft Skills

communicationflexibilityproblem-solvingcollaborationmember engagementorganizational skillsinterpersonal skillsleadershipadaptabilitycritical thinking

Certifications

RN licensure