Case Manager, Registered Nurse - Field - Hospital of the University of Pennsylvania

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.Program OverviewJoin the Aetna Clinical Collaboration (ACC) team - an innovative and growing, community-based care management model designed to transform how we serve our members. ACC utilizes best-in-class clinical and operating models to deliver meaningful, high-impact care where it matters most.ACC is a member-centric, team-delivered approach that meets members where they are. Through compassionate engagement and strong communication, our care teams collaborate with members, providers, and community organizations to address the full continuum of healthcare needs, including medical, behavioral, and social determinants of health.This is an exciting opportunity to be part of a growing program with national expansion, offering the chance to help shape care delivery in new markets and have a life-changing impact on the members we serve.Family SummaryThis role supports the delivery of appropriate benefits and healthcare services by facilitating eligibility determination, promoting wellness activities, and advancing successful, timely health outcomes. The team develops, implements, and supports health strategies, policies, and programs that ensure effective care delivery and overall member wellness. Services span network management, clinical coverage, and evidence-based policies.Position SummaryThe ACC Case Manager applies a collaborative, member-centered approach to assessment, care planning, coordination, evaluation, and advocacy to address the comprehensive health needs of individuals and families. This is an on-site, hospital-based role supporting members receiving care at Hospital of the University of Pennsylvania and requires consistent in-person engagement with members, providers, and multidisciplinary care teams. Candidates must reside within reasonable driving distance of the facility to support reliable on-site presence and timely care coordination.Fundamental Components & Physical RequirementsServe 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 Hospital of the University of Pennsylvania , 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.Required QualificationsCandidate must have active and unrestricted Registered Nurse License (RN) in Pennsylvania (PA)3+ years of clinical experience, preferably with Medicare and Commercial populationsAbility to work independently within a hospital-based environmentStrong analytical, problem-solving, organizational, and communication skillsProficiency in Microsoft Word, Excel, Outlook, PowerPoint, and proprietary clinical systemsEfficient computer skills, including navigating multiple systems and keyboarding.Candidate must have reliable transportation and the ability to consistently meet onsite, hospital based work requirements up to 55-75% of the time at Hospital of the University of PennsylvaniaPreferred Qualifications3+ year of experience in care management, discharge planning, or home health coordinationWillingness to obtain multi-state Registered Nurse (RN) licensure (company supported)National certification (CRC, CDMS, CRRN, COHN, or CCM)EducationAssociate's Degree with equivalent clinical experience (REQUIRED)Bachelor's Degree (PREFERRED)LicenseActive and unrestricted Registered Nurse License (RN) in Pennsylvania (PA)Anticipated Weekly Hours40Time TypeFull timePay RangeThe typical pay range for this role is:$60,522.00 - $129,615.00This 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 peopleWe 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/benefitsWe anticipate the application window for this opening will close on: 04/05/2026