Case Manager Registered Nurse - Field in Union & Surrounding Counties, New Jersey

CVS Health•Field-New Jersey, NJ

1d•$66,575 - $142,576•Remote

About The Position

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. This is a Field/Remote Case Manager opportunity with up to 75% field travel in Union surrounding counties. The working schedule is Monday - Friday 8am-5pm EST. Develop, implement, support, and promote health service strategies, tactics, policies, and programs that drive the delivery of quality healthcare to our members. Health service strategies, policies, and programs are comprised of utilization management, quality management, network management, clinical coverage and policies. The position requires advanced clinical judgment and critical thinking skills to facilitate appropriate physical, behavioral health, psychosocial wrap around services. The care manager will be responsible for care planning, direct provider collaboration, and effective utilization of available resources in a cost-effective manner. Strong assessment, writing and communication skills are required.

Requirements

Must reside in Union County
3+ years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care
Active and Unrestricted RN license in NJ
Must possess reliable transportation and be willing and able to travel 50-75% of the time in Hudson and surrounding counties In New Jersey.
Successful completion of the NJ Choice certification is a contingency of employment. As per NJ Division of Aging Services, Office of Community Choice Options guidance, an exam score of 80% or higher is required, along with successful completion of the State training modules, and field mentoring component.
Minimum associate’s degree or diploma in Nursing required
Must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer
A minimum download speed of 25 mbs download and 3 mbs upload. Wi-Fi and satellite internet are not permitted.
A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines and allowing for uninterrupted work during work hours.
Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
All new hires should provide their own workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and virtual meetings.
Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
Troubleshooting & Support: Ability to resolve common technical issues independently, such as restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.

Nice To Haves

LTSS experience
Case management and/or discharge planning experience
Managed Care experience
Medicaid and Medicare experience
Experience using computer, keyboard, mouse, multi-system navigation; and MS Office Suite applications (Outlook, Word, Excel, SharePoint, Teams)
Future Growth: Openness to learning new skills in the future as the workplace environment evolves

Responsibilities

Conduct face to face visits in the members home utilizing comprehensive assessment tools for members enrolled in Managed Long-Term Services and Supports program (MLTSS) and/or Dual Special Needs Program (D-SNP/ FIDE) and non-MLTSS members to evaluate the medical needs of the member to facilitate the member’s overall wellness and help them obtain the services they need to thrive by addressing requests for services such as adult medical daycare, pediatric medical daycare, personal care assistant, nursing facility custodial requests, personal preference program and MLTSS program enrollment.
Member assignments may include pediatric population and medically complex cases.
Schedule and attend interdisciplinary meetings and advocate on the members’ behalf to ensure proper and safe discharge with appropriate services in place.
Work with the member and care team to develop a care plan and authorize services in a cost-effective manner within the MLTSS/ FIDE benefit.
Document accurately and timely in the member’s electronic health record.
Coordinate and collaborate care with the member/authorized representative, PCP, and any other care team participants.
Use critical thinking skills and the ability to solve problems.
Mentor new hires once a level of proficiency has been attained in their role.