We’re building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary

Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in‑class operating and clinical models. You can have life‑changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country.

Responsibilities

Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.
Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care.
Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician's office to provide ongoing case management services.
Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate.
Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person.
Prepares all required documentation of case work activities as appropriate.
Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes.
May make outreach to treating physician or specialists concerning course of care and treatment as appropriate.
Provides educational and prevention information for best medical outcomes.
Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources.
Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data.
Utilizes case management processes in compliance with regulatory and company policies and procedures.
Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work.
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/client’s overall wellness through integration.
Monitors member/client progress toward desired outcomes through assessment and evaluation.

Remote Work Expectations

This is a remote‑hybrid role; candidates must have a dedicated workspace free of interruptions.
Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.

Required Qualifications

Minimum 3‑5 years clinical practical experience preference required.
Minimum 2‑3 years CM, discharge planning and/or home health care coordination experience.
Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually.
Must possess reliable transportation and be willing and able to travel up to 50‑75% of the time in the Southloop, Chinatown and surrounding areas. Mileage is reimbursed per our company expense reimbursement policy.
Excellent analytical and problem‑solving skills.
Effective communications, organizational, and interpersonal skills.
Ability to work independently.
Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications.
Efficient and effective computer skills including navigating multiple systems and keyboarding.

Preferred Qualifications

Certified Case Manager

Bilingual in English AND Cantonese or Mandarin

Education

Associates Required, Bachelor's preferred

License

Active and unencumbered Registered Nurse License in the state of Illinois

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is: $66,575.00 - $142,576.00

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.

Benefits

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.

EEO Statement

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

#J-18808-Ljbffr