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CVS Health is an American healthcare company working across healthcare services, health insurance, pharmacy benefits management, and retail pharmacy. Through businesses including Aetna and CVS Caremark, it supports health coverage, prescription access, condition management, specialty medications, and mail-order pharmacy services. Its neighborhood pharmacies and broader care offerings are designed to help people access essential healthcare more conveniently and affordably. CVS Health brings together insurance, pharmacy, and health services to support individuals and communities throughout their care journeys.
Field Registered Nurse Case Manager, Houston Hybrid
Manage Aetna members’ clinical needs by coordinating assessments, individualized care plans, and hospital-based services. Partner with care teams through the Aetna Clinical Collaboration program to support coordinated delivery.
Description
- Act as the coordinating contact for members, families, employers, providers, insurers, and healthcare professionals
- Manage care activities for members with catastrophic or chronic conditions throughout the care continuum
- Arrange specialist consultations, home care, community support, and alternative care settings
- Engage with members by phone and in person while working at Houston Methodist West Hospital
- Visit members during inpatient stays
- Evaluate medical, functional, and vocational needs
- Create and put into action personalized care plans
- Coordinate communication with providers, attorneys, employers, and insurers
- Complete accurate case management records within required timeframes
- Work with internal multidisciplinary care teams
- Contact treating physicians and specialists as part of member outreach
- Deliver health education and preventive guidance
- Follow relevant laws, regulations, and payer policies
- Track member outcomes and revise care plans when needed
- Design proactive approaches for complex needs and near- and long-term wellness goals
Requirements
- Hold an active, unrestricted Texas Registered Nurse (RN) license
- Bring at least three years of clinical experience, preferably with Medicare and commercial populations
- Work independently in a hospital-based setting
- Demonstrate strong analytical, problem-solving, organizational, and communication abilities
- Use Microsoft Word, Excel, Outlook, PowerPoint, and proprietary clinical platforms effectively
- Navigate multiple systems and perform computer-based tasks efficiently
- Have dependable transportation
- Meet onsite hospital work requirements at Houston Methodist West Hospital for approximately 50–75% of the role
- Possess an Associate’s Degree in Nursing and equivalent clinical experience
- Be willing to obtain multistate RN licensure with company support
- Have care management, discharge planning, or home health coordination experience preferred
- Hold a national certification such as CRC, CDMS, CRRN, COHN, or CCM preferred
- Comfortably configure and use multiple monitors while working across applications
- Communicate using email, calendar invitations, Teams messages, and virtual meetings
- Use Microsoft Office 365 or comparable Google Workspace tools
- Safely access secure systems, VPNs, and EHR portals; protect screens and passwords; and identify suspicious messages or links
- Resolve routine technical problems without assistance
- Remain willing to develop new skills as workplace needs change
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- Paid time off
- Retirement savings programs
- Wellness initiatives
- Additional resources for physical, emotional, and financial well-being
- Potential CVS Health bonus, commission, or short-term incentive in addition to base salary
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