Case Manager Licensed Practical Nurse Field - Arlington, Alexandra and Fairfax, VA

's overall wellness. 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. Services strategies policies and programs are comprised of network management and clinical coverage policies.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 take into account 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 Qualifications

• LPN with current unrestricted Virginia state licensure required

• 3+ years clinical experience as a LPN ( behavioral health, acute/subacute care)

• Must reside in Northern Virginia, specifically Fairfax County or Surrounding Areas

• Must be willing and able to travel up to 75% of the time to meet members in their homePreferred Qualifications

• Case Management in an integrated model preferred

• Bilingual in English/Spanish preferred

• Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment

• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding.

• Effective communication skills, both verbal and written.Education

• Associate degree requiredRequisition Job Description

A Brief Overview
Coordinates all case management activities with members to evaluate medical needs and to facilitate the overall wellness of members. Develops strategy to address issues to outcomes and opportunities to enhance member's overall wellness through integration. Instructs programs and procedures in compliance with network management and clinical coverage policies.

What you will do

• Executes evaluation of member needs and benefit plan eligibility and facilitates member transition to the organization's programs and plans.

• Applies advanced clinical judgement to incorporate strategies designed to reduce risk factors and barriers, and to address complex health indicators that impact care planning and resolution of member issues.

• Handles reviews of prior claims to address potential impact on current case management and eligibility.

• Creates a holistic approach to assess the need for referrals to clinical resources and to assist in determining functionality.

• Ensures case management processes follow organization and regulatory requirements.

• Implements systems to maximize member engagement, discern health status and needs, and to assess member levels of work capacity and restrictions.

• Coaches and trains junior colleagues in techniques, processes, and responsibilities.

For this role you will need Minimum Requirements

• Basic awareness of problem solving and decision making skills

Anticipated Weekly Hours
40Time Type
Full timePay Range

The typical pay range for this role is:$22.40 - $48.67This 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.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 peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 12/05/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.