Cvs Rn Jobs in Houston, TX (NOW HIRING)

Help us elevate patient care to a whole new level.Join the Aetna Clinical Collaboration (ACC) team-an innovative and growing, communitybased care management model designed to transform how we serve our members. ACCutilizesbestinclass clinical and operating models to deliver meaningful, highimpact care where it matters most.

ACC is a membercentric, teamdelivered approach that meets members where they are. Through compassionate engagement andstrong 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 nationalexpansion,offering the chance to help shape care delivery in new markets and have a lifechanging impact on the members we serve.

Family Summary

This role supports the delivery ofappropriate benefitsand healthcare services byfacilitatingeligibility determination, promoting wellness activities, and advancing successful,timelyhealth 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 evidencebased policies.

Position Summary

The ACC Case Manager applies a collaborative, membercentered approach to assessment, care planning, coordination, evaluation, and advocacy to address the comprehensive health needs of individuals and families. This is an onsite, hospitalbased role supporting members receiving care at Houston Methodist - Woodlands, requiring consistent inperson engagement with members, providers, and multidisciplinary care teams. Candidates mustresidewithin reasonable driving distance of both facilities to support reliable onsite presence andtimelycare coordination.

Fundamental Components & Physical Requirements

• Serve as a liaison between members/clients, families, employers, providers, insurance carriers, and healthcare personnel asappropriate.

• 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 onsite at Houston Methodist - Woodlands, including meeting with members during inpatient admissions.

• Assess medical, functional, and vocational status to develop and implement individualized plans of care that supportoptimalhealth outcomes, benefits eligibility, andtimelyreturn to work or baseline functioning.

• Communicate effectively with stakeholders including medical providers, attorneys, employers, and insurance carriers.

• Preparetimelyandaccuratedocumentation of all case management activities.

• Collaborate with internal multidisciplinary teams to supportoptimalmember outcomes.

• Conduct outreach to treating physicians and specialists to supportappropriate careplanning.

• 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 shortand longterm wellness outcomes.

Required Qualifications

• Candidate must have active and unrestricted Registered Nurse License (RN) in Texas (TX)

• Reliable transportation and the ability to consistently meet onsite,hospitalbasedwork requirements atHouston Methodist - Woodlands (up to 55-75%)

• 3+ years of clinical experience, preferably with Medicare and Commercial populations.

• Ability to work independently within a hospitalbased environment.

• Strong analytical, problemsolving, organizational, and communication skills.

• Proficiencyin Microsoft Word, Excel, Outlook, PowerPoint, and proprietary clinical systems.

• Efficient computer skills, including navigating multiple systems and keyboarding

Preferred Qualifications

• 3+yearof experience in care management, discharge planning, or home health coordination

• Willingness to obtain multistate RN licensure (company supported)

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

Education

• Associate'sDegree in Nursing with equivalent clinical experience(REQUIRED)

• Bachelor's Degree in Nursing (PREFERRED)

License

• Active and unrestricted Registered Nurse License (RN) in Texas (TX)