Remote RN Case Manager (Case Management & Utilization Management)

We're building a world of health around every individual , shaping a more connected, convenient and compassionate health experience.

Aetna National Medical Excellence (NME) is seeking an experienced Registered Nurse (RN) Case Manager to join our growing team. This is a fully remote opportunity open to candidates nationwide, with preference given to nurses residing in compact licensure states.

In this blended role, you will combine Case Management and Utilization Management expertise to support members with complex healthcare needs. You'll partner with members, providers, and interdisciplinary teams to develop personalized care plans, improve health outcomes, reduce barriers to care, and promote overall wellness.

Responsibilities

• Assess, coordinate, and manage care for members with complex medical needs
• Develop proactive care plans to improve short- and long-term health outcomes
• Identify clinical, social, and functional barriers impacting care
• Collaborate with healthcare providers and multidisciplinary teams
• Utilize clinical judgment to support effective utilization and care management decisions
• Engage members through telephonic care management and health coaching

Required Qualifications

• Active, unrestricted Compact RN license in state of residence
• 5+ years of RN clinical practice experience
• 2+ years of critical care experience
• 6+ months of Case Management or Utilization Management experience
• Ability to work Monday-Friday, 8:00 AM-5:00 PM in your local time zone. Weekends and Holidays are based on business needs.
• Willingness to obtain additional state RN licenses (company-paid)

Preferred Qualifications

• Case Management Certification (CCM or equivalent)
• Transplant nursing experience
• BSN preferred

Benefits

• 100% remote work environment
• No nights, weekends, or holidays currently required
• Company-sponsored multi-state licensure
• Opportunity to impact members' lives through innovative, integrated care management

Work from Home Requirements

• You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.
• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
• The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
• If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.