A1A Oncology Case Manager RN - Registered Nurse - NC

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary:

This RN Case Manager role is part of Aetna One Advocacy (A1A) and requires in office training and ongoing work in High Point, NC. There is a requirement to live within a commutable distance of High Point, NC (typically within 45 minutes maximum).

The expected start date for the cohort is October 13, 2025.

The team is hiring an RN with at least 2 years of oncology experience.

The initial in office training will last for approximately 4 months.
Once office training is complete, the role is work from home with occasional in office workdays scheduled in advance with the employee.

There will be an expectation that the Case Manager works in the office at least one time per quarter for further training but it may be more often, and notice will be provided.

Normal Working Hours: Once training is completed, various shifts are available including 8am-4:30pm EST, 9am-5:30pm EST and 3pm-11:30pm EST. There are no weekend shifts. Note: Training hours will likely be between 8am-5pm EST but may vary. Flexibility is required for onsite work shifts per the need of the business.

What is A1A? Aetna One Advocate is Aetna’s premier service and clinical offering for Aetna nation-wide and creates industry-leading solutions for our customers and members. The model is a fully integrated population health and customer service solution for large plan sponsors. The high-touch, high-tech member advocacy service combines data-driven processes with the expertise of highly trained clinical and concierge member services. Our mission is to meet each member at every aspect of their health care journey. Our embedded customer-dedicated service and clinical pods allow maximization of inbound and outbound touchpoints to solve members’ needs and create behavior change. Our data analytics, white-glove service and end-to-end ownership of member support creates a trusted partner in health. This is an exciting time to join Aetna, a CVS Health company, in our journey to change the way healthcare is delivered today. We are health care innovators.

The RN Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.

RN Case Manager:
– 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 overall wellness through integration.
– Through the use of clinical tools and information/data review, conducts an evaluation of member’s needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
– Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
– Assessments consider information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
– Reviews prior claims to address potential impact on current case management and eligibility.
– Assessments include the member’s level of work capacity and related restrictions/limitations.
– Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.
– Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
– Utilizes case management processes in compliance with regulatory and company policies and procedures.
– Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Required:

- A Reg