Case Manager - Registered Nurse

$60,522 - $129,615 / YEAR

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.

Job Summary

The Care Manager—Registered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible for coordinating care for members who often face multiple chronic medical and behavioral health conditions, as well as various social determinants of health (SDoH) needs. This role involves conducting comprehensive assessments to evaluate members’ needs and addressing SDoH challenges by connecting them with appropriate resources and support services. The Social Worker provides education and guidance to members and their families on managing chronic conditions and navigating the healthcare system. Additionally, the Care Manager develops and implements individualized care plans, monitors member progress, advocates for necessary services, and collaborates with the interdisciplinary care team to ensure optimal health outcomes. Accurate and timely documentation of assessments and interventions is essential, as is participation in team meetings to discuss member status and care strategies.

Key Responsibilities

50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care.
Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member’s identified needs.
Provides evidence-based disease management education and support to help the member achieve health goals.
Ensure the appropriate members of the interdisciplinary care team are involved in the member’s care.
Provides care coordination to support a seamless health care experience for the member.
Meticulous documentation of care management activity in the member’s electronic health record.
Collaborate with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition.
Identifies and connects members with health plan benefits and community resources.
Meets regulatory requirements within specified timelines.
The Care Manager RN supports other members of the Care Team through clinical decision making and guidance as needed.
Additional responsibilities as assigned by leadership to support team objectives, enhance operational efficiency, and ensure the delivery of high-quality care to members. This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members.

Essential Competencies and Functions

Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements of this role.
Conduct oneself with integrity, professionalism, and self-direction.
Experience or a willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care.
Familiarity with community resources and services.
Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records.
Maintain strong collaborative and professional relationships with members and colleagues.
Communicate effectively, both verbally and in writing.
Excellent customer service and engagement skills.

Required Qualifications

Candidate must have active and unrestricted Registered Nurse (RN) licensure in the state of Pennsylvania (PA) OR Compact Registered Nurse (RN) licensure in state of residence
Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the Care Manager Registered Nurse (RN) role
Access to a private, dedicated space to conduct work effectively to meet the requirements of the position
Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually
3+ years of nursing experience
2+ years of case management, discharge planning and/or home healthcare coordination experience

Preferred Qualifications

Experience providing care management for Medicare and/or Medicaid members
Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health
Experience conducting health-related assessments and facilitating the care planning process
Bilingual skills, especially English-Spanish

Education

Associate’s of Science in Nursing (ASN) degree AND relevant experience in a health care-related field (REQUIRED)
Bachelor’s of Science in Nursing (BSN) (PREFERRED)

License

Active and unrestricted Registered Nurse (RN) licensure in the state of Pennsylvania (PA) OR Compact Registered Nurse licensure in state of residence

Anticipated Weekly Hours

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: 03/06/2026

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

Share this job

Related Jobs

Full-time

RN Registered Nurse, ARU, AVH, Full Time

apartment Allegheny Health Network location_onNatrona Heights, PA

Company Allegheny Health Network Job Description Sign on bonus of up to $30,000 offered to qualifying candidates At AHN, employees trust working together and place patients at the center of all they do. This 9 Hospital system, a part of Highmark Health, is transforming the future of healthcare by providing highly effective services to customers, patients and communities. AHN has commitment and dedication to being inclusive, valuing fresh perspectives, and offering the best growth and educational opportunities to employees. Allegheny Valley Hospital is a 188 bed community, union hospital serving the surrounding neighborhoods of Natrona Heights. AHN Allegheny Valley’s Inpatient Rehab Unit is a comprehensive unit with 17 specialized beds for those with complex illnesses, post-stroke, and surgical needs. They are also certified to provide rehabilitation services to patients with traumatic brain injuries (TBI), spinal cord, and orthopedic needs. This unit provides intensive structured therapy to their patients at least 3 hours a day, 5 days per week. You will work with a collaborative team including social workers, respiratory therapists, nutritionists, physiatrist, and others. Our nurses are specially trained in rehabilitation, providing exceptional care to prepare patients for the next stage in their recovery. General Overview Utilizes the nursing process to provide and direct delivery of patient care in accordance with established policies, procedures and protocols for inpatients, outpatients, and emergency room patients. Essential Responsibilities Performs a comprehensive patient assessment to identify patient needs. (25%) Develops and implements a comprehensive plan of care. (20%) Performs and documents direct patient care and patient education according to nursing standards of practice. (20%) Identifies and responds to patient condition to achieve positive patient outcomes. (20%) Directs and delegates care provided by ancillary team members. (15%) Qualifications Minimum Act 34 Criminal Background Clearance Certificate Act 33 Child Abuse Clearance Certificate Act 73 FBI Fingerprinting Criminal Background Clearance Certificate Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). CPR certification Disclaimer The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Full-time

Company Allegheny Health Network Job Description Date Posted 20260130 Location Allegheny General Hospital Department Infection Prevention Status Full Time Shift 80 hours every two weeks Monday - Friday, Daylight Union Yes THE UNIT Allegheny General’s Infection Prevention Department focuses on the collection, analysis and interpretation of healthcare-associated infection data to prevent the spread of infection and ensure compliance with required regulations. Additionally, the team focuses on continued education for staff, providers and patients related to infection prevention. ALLEGHENY GENERAL HOSPITAL AGH is a Level I Shock Trauma Center 5 state of the art ICU’s State of the art Cancer Center 550+ Beds ALLEGHENY HEALTH NETWORK At AHN, employees trust working together and place patients at the center of all they do. This 9 Hospital system, a part of Highmark Health, is transforming the future of healthcare by providing highly effective services to customers, patients and communities. AHN has commitment and dedication to being inclusive, valuing fresh perspectives, and offering the best growth and educational opportunities to employees. General Overview The Infection Preventionist under the direction of the Manager of Infection Prevention is a position responsible for implementing hospital-wide infection prevention programs while ensuring compliance with the mandates of required accrediting and regulatory agencies. They instruct staff on proper infection prevention procedures, conduct rounds, investigate infection prevention problems, and collect any necessary data in order to ensure best practices with the infection prevention programs and policies. Essential Responsibilities Performs routine surveillance for healthcare associated infections. Provide educational in-services and materials for patients, visitors, and healthcare workers. Assures hospital compliance with regulatory, safety, and infection control standards. Identify and monitor patients requiring isolation precautions to ensure appropriate precautions are used. Recognize possible epidemiological exposures and provides appropriate follow-up. Maintains interdepartmental communications with all hospital areas regarding infection control issues. Maintains self-education regarding infection control standards and the Joint Commission and DOH regulations. Other duties as assigned. Qualifications Minimum Associate’s degree in Nursing, Medical Technology, Public Health, Epidemiology or related field 3 years clinical experience in a hospital or related setting or disease surveillance experience in a public health setting Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) Certification in Infection Prevention and Control within 3 years of hire CPR – American Heart Association Act 34 Criminal Background Clearance Certificate Act 33 Child Abuse Clearance Certificate Act 73 FBI Fingerprinting Criminal Background Clearance Certificate Preferred Bachelor’s degree in Nursing, Medical Technology, Public Health, Epidemiology or related field Infection Prevention experience Disclaimer The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Full-time

RN Surgical Procedures Unit - Allegheny General Hospital

apartment Allegheny Health Network location_onPittsburgh, PA

Company Allegheny Health Network Job Description Date Posted 20260130 Location Allegheny General Hospital Department Surgical Procedures Unit Status Full Time Shift 80 hours every two weeks Monday thru Friday The shifts are rotational from 530 am to as late as 830pm. No call time & no Holidays scheduled Union Yes Allegheny General Hospital AGH is a Level I Shock Trauma Center 5 state of the art ICU’s State of the art Cancer Center550+ Beds Allegheny Health Network At AHN, employees trust working together and place patients at the center of all they do. This 9 Hospital system, a part of Highmark Health, is transforming the future of healthcare by providing highly effective services to customers, patients and communities. AHN has commitment and dedication to being inclusive, valuing fresh perspectives, and offering the best growth and educational opportunities to employees General Overview Responsible and accountable for a designated patient population for the purpose of providing care based upon enactment of the nursing process. Essential Responsibilities Demonstrates clinical assessment skills and care planning skills. Provides safe and effective care for the age population served according to regulatory requirements. Professionally directs and manages the activities of the patient care delivery by the team members. Collaborates with the multidisciplinary team for the plan of care from admission through discharge. Assesses learning needs of patient and family and provides education based on age, culture and willingness to learn. Qualifications Minimum Act 34 Criminal Background Clearance Certificate Act 33 Child Abuse Clearance Certificate Act 73 FBI Fingerprinting Criminal Background Clearance Certificate Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). CPR certification 2 Years RN Experience Disclaimer The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice