At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. **Position Summary** - Coordinates all case management activities with members to evaluate medical needs and to facilitate the overall wellness of members. - Develops strategy to address issues to outcomes and opportunities to enhance member's overall wellness through integration. Instructs programs and procedures in compliance with network management and clinical coverage policies. - Executes evaluation of member needs and benefit plan eligibility and facilitates member transition to the organization's programs and plans. Applies advanced clinical judgement to incorporate strategies designed to reduce risk factors and barriers, and to address complex health indicators that impact care planning and resolution of member issues. - Handles reviews of prior claims to address potential impact on current case management and eligibility. - Creates a holistic approach to assess the need for referrals to clinical resources and to assist in determining functionality. - Ensures case management processes follow organization and regulatory requirements. - Implements systems to maximize member engagement, discern health status and needs, and to assess member levels of work capacity and restrictions. - Coaches and trains junior colleagues in techniques, processes, and responsibilities **Required Qualifications** - Must have an active, current, and unrestricted RN Licensure in Virginia - 3+ years clinical practice experience as an RN required - 2+ years’ experience using personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.) - 2+ years of Case Management experience - Must reside in the Tidewater Region of Virginia - Must possess reliable transportation and be willing and able to travel up to 25-50% of the time to meet members face to face in the Tidewater Region of VA. Mileage is reimbursed per our company expense reimbursement policy **Preferred Qualifications** - Ability to organize, multitask, prioritize and effectively adapt to a fast-paced changing environment. - Basic awareness of problem solving and decision making skills - Effective communication skills, both verbal and written **Education** - Associates degree in nursing or RN diploma required - Bachelor's of Science and Nursing preferred **Anticipated Weekly Hours** 40 **Time Type** Full time **Pay Range** The typical pay range for this role is: $60,522.00 - $129,615.00 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 – 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 https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 07/06/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.