Case Manager, RN – Field

CVS Health

Case Manager RN conducting assessments and case management for members' wellness at CVS Health. Requires West Virginia residency with extensive travel within the region.

Posted 7/30/2026full-timeSouth Charleston • Virginia, West Virginia • 🇺🇸 United StatesMid-LevelSenior💰 $54,095 - $116,760 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in clinical assessment and case management, utilizing a holistic approach to evaluate member needs and facilitate transitions to appropriate programs. Proficient in regulatory compliance and effective communication to enhance member engagement and care planning.

Highest-signal resume keywords

Registered Nurse LicenseClinical Practice ExperienceCase Management ProcessesMS Office Suite ApplicationsMultitasking and Prioritization

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical AssessmentCare PlanningRisk Factor ReductionData ReviewReferral to Clinical Resources

Soft Skills

Interpersonal SkillsEffective CommunicationAdaptability

Tools & Technologies

MS Office SuiteSharePointTeams

Certifications & Qualifications

Registered Nurse License

Industry Keywords

Case ManagementRegulatory ComplianceMember EngagementHolistic ApproachCo-morbid Conditions

About the role

Key responsibilities & impact

Conducts face to face member visits
Using clinical tools and information/data review, conducts an 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.
Assesses information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
Reviews prior claims to address potential impact on current case management and eligibility.
Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.
Consults with supervisor and others in overcoming 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 interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment.

Requirements

What you’ll need

Registered Nurse with current unrestricted West Virginia (WV) license or Registered Nurse with current unrestricted WV or ”multi-state privilege” license
5+ years’ clinical practice experience
2+ years’ experience with personal computer, keyboard, mouse, multi-system navigation; and MS Office Suite applications (Outlook, Word, Excel, SharePoint, Teams)
Must possess reliable transportation and be willing and able to travel in the assigned region 50% or more, of the time.

Benefits

Comp & perks

medical coverage
dental coverage
vision coverage
paid time off
retirement savings options
wellness programs