Hybrid Case Manager, Registered Nurse – Field

at CVS Health

• Job title: Case Manager, Registered Nurse – Field
• Job type: Full Time
• Experience level: Mid level, Senior
• Salary: $66,575 - $142,576 per year
• Degree requirement: Associate's Degree
• Location requirements: Hybrid, MacHesney Park, United States

About the role

• Case Manager supporting healthcare teams through assessment and care planning at Swedish American Hospital. Requires on-site presence in Illinois for coordinated patient support.

Responsibilities

• Serve as a liaison between members/clients, families, employers, providers, insurance carriers, and healthcare personnel as appropriate.
• Implement and coordinate case management activities for catastrophic and chronically ill members across the continuum of care, including consultant referrals, home care, community resources, and alternative levels of care.
• Interact with members/clients both telephonically and in person while working on‑site at Swedish American Hospital , including meeting with members during inpatient admissions.
• Assess medical, functional, and vocational status to develop and implement individualized plans of care that support optimal health outcomes, benefits eligibility, and timely return to work or baseline functioning.
• Communicate effectively with stakeholders including medical providers, attorneys, employers, and insurance carriers.
• Prepare timely and accurate documentation of all case management activities.
• Collaborate with internal multidisciplinary teams to support optimal member outcomes.
• Conduct outreach to treating physicians and specialists to support appropriate care planning.
• Provide education and preventive guidance to promote best clinical outcomes.
• Apply applicable laws, regulations, and payer requirements related to rehabilitation and case management services.
• Monitor member progress toward desired outcomes and adjust care plans as needed.
• Develop proactive strategies to address complex needs and support both short‑ and long‑term wellness outcomes.

Requirements

• Candidate must have active and unrestricted Illinois Registered Nurse (RN) License
• 3+ years of clinical experience, preferably with Medicare and Commercial populations
• Ability to work independently within a hospital‑based environment
• Strong analytical, problem‑solving, organizational, and communication skills
• Proficiency in MS Word, Excel, Outlook, PowerPoint, and proprietary clinical systems
• Efficient computer skills, including navigating multiple systems and keyboarding
• Reliable transportation and the ability to consistently meet on‑site, hospital‑based work requirements at Swedish American Hospital
• 1+ year(s) of experience in care management, discharge planning, or home health coordination (Preferred)
• Willingness to obtain multi‑state RN licensure (company supported) (Preferred)
• National certification (CRC, CDMS, CRRN, COHN, or CCM) (Preferred)

Benefits

• Affordable medical plan options
• 401(k) plan (including matching company contributions)
• 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.