Case Manager Registered Nurse - Field in Middlesex and surrounding Counties NJ

CVS Health•South Plainfield, NJ

2d•$66,575 - $142,576•Remote

About The Position

In this role, you will develop, implement, and support health service strategies, policies, and programs that promote high‑quality care for our members. These initiatives include utilization management, quality management, network management, and clinical coverage policies. The position requires advanced clinical judgment, strong critical‑thinking abilities, and the capacity to coordinate physical, behavioral, and psychosocial support services. Responsibilities include care planning, direct collaboration with providers, and effective resource utilization. Strong assessment, written documentation, and communication skills are essential.

Requirements

Active, unrestricted RN license in the state of New Jersey.
Minimum of 3 years of clinical experience in settings such as hospitals, home health, or ambulatory care.
Residency in Middlesex County, NJ
Must possess reliable transportation and be willing and able to travel up to 75% of the time. Mileage is reimbursed per our company expense reimbursement policy
Successful completion of NJ Choice Certification, including: Exam score of 80% or higher, Completion of state training modules, Field mentoring, as required by the NJ Division of Aging Services

Nice To Haves

Experience in case management and/or discharge planning
Background in managed care
Crisis intervention skills

Responsibilities

Conduct face‑to‑face home visits using comprehensive assessment tools for members enrolled in Managed Long‑Term Services and Supports (MLTSS) and/or Dual Special Needs Programs (D‑SNP/FIDE).
Perform in‑person assessments for non‑MLTSS members to determine medical needs and support appropriate service referrals (e.g., adult medical daycare, pediatric medical daycare, personal care assistant services, nursing facility custodial care, Personal Preference Program, and MLTSS enrollment).
Successfully complete and maintain NJ Choice Certification (required for continued employment).
Work with diverse populations, including pediatric and medically complex members.
Coordinate and collaborate with members, authorized representatives, primary care providers, and interdisciplinary care teams.
Schedule and participate in interdisciplinary meetings, advocating for members to ensure safe transitions and appropriate services.
Develop individualized care plans and authorize services within MLTSS/FIDE program benefits in a cost‑effective manner.
Document all assessments, interactions, and care planning activities accurately and in a timely manner in the electronic health record.
Utilize strong critical‑thinking and problem‑solving skills in daily work.
Mentor new staff once appropriate proficiency has been achieved.