Case Manager Registered Nurse - Field (Ocean County, NJ)

CVS Health•Jersey City, NJ

1d•$66,575 - $142,576•Hybrid

About The Position

CVS Health is hiring an Integrated Care Management (ICM) Care Manager to serve dual-eligible members enrolled in Medicare and Medicaid who may have complex health and social challenges. The role is a flexible work-from-home position serving Ocean County, New Jersey, with 25–50% travel within a radius of up to 50 miles from the employee’s home. Standard working hours are Monday through Friday, 8 a.m. to 5 p.m. The care manager serves as a frontline advocate for members and assesses, plans, implements, and coordinates case management activities to evaluate medical needs and support overall wellness. The role develops proactive care plans, reviews clinical tools and data, applies clinical judgment to address health and social barriers, and considers claims and other information when assessing conditions that affect member functionality. The care manager uses a holistic approach to determine referrals to clinical resources and interdisciplinary team members, collaborates with supervisors and healthcare stakeholders, and presents cases at interdisciplinary conferences. The role follows regulatory and company policies and uses motivational interviewing to support member engagement and understand members’ health status and needs. Members may be met in a public place when appropriate; a security escort is available if needed. Travel requires use of the employee’s own vehicle, and mileage is reimbursed under the company expense reimbursement policy.

Requirements

At least 3 years of clinical practice experience.
Active and unrestricted RN license in New Jersey.
Willingness and ability to travel 25–50% of the time using a personal vehicle to meet members face to face.
Reliable transportation.
Residence in Ocean County or a surrounding county in New Jersey.
Associate’s degree in Nursing.

Nice To Haves

Certified Case Manager credential.
At least 2 years of experience in care management, discharge planning, and/or home health care coordination.
Confidence working from home and thinking independently while using tools to collaborate and connect with teams virtually.
Strong analytical and problem-solving skills.
Effective communication, organizational, and interpersonal skills.
Ability to work independently.
Effective computer skills, including navigating multiple systems and keyboarding.
Proficiency with standard corporate software applications, including Microsoft Word, Excel, Outlook, and PowerPoint, and some proprietary applications.
Bilingual ability.
Bachelor’s degree.

Responsibilities

Assess, plan, implement, and coordinate case management activities to evaluate members’ medical needs and support overall wellness.
Develop proactive plans of care to address identified issues and improve short- and long-term outcomes.
Use clinical tools and information or data reviews to evaluate members’ needs and benefits.
Apply clinical judgment and strategies to reduce risk factors and barriers and address complex health and social indicators that affect care planning.
Conduct assessments using information from sources such as claims and account for co-morbidities and multiple diagnoses that affect functionality.
Holistically assess whether referrals to clinical resources or interdisciplinary team members are needed.
Collaborate with supervisors and other healthcare stakeholders to overcome barriers to members’ goals and objectives.
Present cases at interdisciplinary case conferences.
Use case management processes in compliance with regulatory requirements and company policies and procedures.
Use motivational interviewing to encourage member engagement and understand health status and needs.
Travel within the assigned area to meet members face to face.