Case Manager, Registered Nurse – Field – Houston Methodist Hospital Main

Join CVS Health's Aetna Clinical Collaboration (ACC) team as a Case Manager, Registered Nurse in a hospital-based field role at Houston Methodist Hospital Main. This is an on-site position supporting members receiving inpatient and outpatient care through a member-centered, collaborative care management model. You will work directly with members, families, providers, and multidisciplinary care teams to address comprehensive health needs including medical, behavioral, and social determinants of health.

This role requires consistent in-person engagement at the hospital and candidates must reside within reasonable driving distance to support reliable on-site presence and timely care coordination. You will be on-site 50-75% of the time.

Responsibilities

• Serve as a liaison between members, families, employers, providers, insurance carriers, and healthcare personnel
• 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 both telephonically and in person while working on-site at Houston Methodist Hospital, 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

• Active and unrestricted Registered Nurse (RN) license in Texas
• 3 or more 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 MS Word, Excel, Outlook, PowerPoint, and proprietary clinical systems
• Efficient computer skills, including navigating multiple systems and keyboarding
• Reliable transportation and ability to consistently meet on-site, hospital-based work requirements at Houston Methodist Hospital up to 50-75%

Preferred Qualifications

• 3 or more years of experience in care management, discharge planning, or home health coordination
• Willingness to obtain multi-state RN licensure (company supported)
• National certification (CRC, CDMS, CRRN, COHN, or CCM)

Education

• Associate's Degree in Nursing with equivalent clinical experience (required)
• Bachelor's Degree (preferred)

Licenses and Certifications

• Active and unrestricted Registered Nurse (RN) license in Texas (required)

Technical Requirements

• Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously
• Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings
• Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) or similar applications
• Ability to log into secure systems (VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links
• Ability to resolve common technical issues independently, such as restarting applications, resolving internet connection issues, and contacting IT for unresolved issues
• Openness to learning new skills as the workplace environment evolves

Schedule and Employment

• Full-time position
• 40 anticipated weekly hours
• On-site at Houston Methodist Hospital 50-75% of the time

Compensation and Benefits

• Base salary range: $60,522.00 - $129,615.00 annually
• Eligible for CVS Health bonus, commission, or short-term incentive program in addition to base pay
• Comprehensive benefits package including medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Additional resources based on eligibility

Application Deadline

The application window is anticipated to close on November 2, 2026.