Description

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.

Position Summary

Join 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 Summary/Mission

This 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 Summary/Mission

The 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 Geisinger Community Medical Center 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 Requirements

• Serve 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 Geisinger Community Medical Center, 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 Qualifications

• Candidate must have active and unrestricted Registered Nurse (RN) License in the state of Pennsylvania (PA)
• 3+ years of clinical experience, preferably with Medicare and Commercial populations

• Ability to work independently within a hospital‑based environment

• Strong analytical, problem‑solving, organizational, and communication skills

• Proficiency in Microsoft Word, Excel, Outlook, PowerPoint, and proprietary clinical systems

• Efficient computer skills, including navigating multiple systems and keyboarding

• Reliable transportation and the ability to consistently meet onsite, hospital‑ based‑ work requirements at Geisinger Community Medical Center

Preferred Qualifications

• 3+ year of experience in care management, discharge planning, home health coordination, or utilization management

• Willingness to obtain multi‑state Registered Nurse (RN) licensure

• National certification (CRC, CDMS, CRRN, COHN, or CCM)

Education

• Associate's Degree with equivalent clinical experience (REQUIRED)
• Bachelor's Degree (PREFERRED)

Anticipated Weekly Hours
40

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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 07/04/2026

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