Case Manager RN - Field (Richmond/Central Virginia)

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 Overview Join a team dedicated to improving health outcomes for Medicare and Medicaid members with complex medical, behavioral, and social needs. As an RN Case Manager, you will play a critical role in delivering holistic, member-centered care by collaborating with members, caregivers, providers, community partners, and interdisciplinary teams. This position offers an opportunity to make a meaningful impact by addressing clinical needs, social determinants of health, and care coordination challenges while supporting members in achieving their health and wellness goals.

Summary This is a field-based position located in Richmond VA/Central Region . Candidates must reside within a commutable distance of the assigned service area. The RN Case Manager serves as a frontline advocate for members, providing comprehensive care management services through telephonic, virtual, home-based, community-based, and facility-based interactions. Responsibilities include assessing member needs, developing individualized care plans, coordinating services, addressing barriers to care, and promoting improved health outcomes through effective care management interventions. The role requires conducting visits in members' homes, hospitals, skilled nursing facilities, and other care settings as needed to support transitions of care, discharge planning, and ongoing care coordination. Work Schedule: Monday–Friday, 8:00 AM–5:00 PM EST Key Responsibilities Conduct face-to-face visits with members in a variety of settings, including homes, hospitals, skilled nursing facilities, rehabilitation centers, and other community-based locations, as appropriate. Conduct comprehensive assessments of members' medical, behavioral health, functional, psychosocial, and social determinant needs. Collaborate with hospital care teams to support discharge planning, transition-of-care activities, and post-discharge follow-up. Develop, implement, monitor, and update individualized care plans that support member goals and improve health outcomes. Utilize clinical judgment, evidence-based practices, and available data to identify risks, gaps in care, and opportunities for intervention. Coordinate services across the continuum of care, including providers, specialists, community resources, and interdisciplinary teams. Coordinate with facility staff and treating providers to address barriers to discharge, medication adherence, follow-up appointments, and community support needs. Facilitate transitions of care and support members in navigating complex healthcare systems. Identify and address barriers that may impact treatment adherence, access to care, and overall wellness. Identify members during inpatient admissions and engage with members, caregivers, and providers to facilitate safe, timely, and appropriate transitions across the continuum of care. Apply motivational interviewing and member engagement techniques to encourage participation in care plans and self-management activities. Collaborate with healthcare providers, caregivers, and community organizations to support comprehensive care delivery. Participate in interdisciplinary case conferences and consult with leadership as needed regarding complex cases. Maintain accurate and timely documentation in accordance with regulatory, accreditation, and organizational requirements. Ensure compliance with all applicable federal, state, and company policies, procedures, and standards.

Active and unrestricted Registered Nurse (RN) license in