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Position Summary
This Case Management position is with Aetna’s Long-Term Services and Supports (LTSS) team and is a Work From Home.
Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. Sedentary work involving periods of sitting, talking, listening.
Work requires sitting for extended periods, talking on the telephone, and typing on the computer
Nurse Case Manager is responsible for reviewing provider requests, including DMAS documents, MD orders, provider justification for services and internal assessment, InterRai and NCQA notes. 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 through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies. Through the use of 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. Assessments take into account 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.
Required Qualifications
- Registered Nurse with current unrestricted Virginia or Compact Licensure
- 3 years Clinical Experience (Preferably in Medical-Surgical Nursing, Behavioral Health, Long term Care, Utilization Review etc.)
- 1+ years Managed Care experience.
- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.
Preferred Qualifications
- Effective communication skills, both verbal and written.
Education
Associates Degree
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 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: 05/31/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
