Case Manager Registered Nurse – Field – Must reside in Atlantic or Cape May County

CVS Health•Margate City, NJ

21h•Hybrid

About The Position

This is a full-time remote opportunity with 50 to 75% travel in Atlantic and Cape May County and surrounding counties. The 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. The Case Manager is responsible for conducting 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). Care manager may also be responsible for face-to-face assessments with 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. Successful completion of company sponsored NJ Choice Certification is requirement for continued employment. Member assignment may include pediatric population and medically complex cases. The case manager is responsible for coordinating and collaborating care with the member/authorized representative, PCP, and any other care team participants. The case manager schedules and attends interdisciplinary meetings and advocates on the members behalf to ensure proper and safe discharge with appropriate services in place. The case manager works with the member and care team to develop a care plan and authorizes services in a cost-effective manner within the MLTSS/ FIDE benefit. The care manager is responsible for documenting accurately and timely in the member’s electronic health record. This position requires the case manager to use critical thinking skills and the ability to problem solve. The Case Manager will also be expected to mentor new hires, once, a level of proficiency has been attained in their role.

Requirements

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 reside in Atlantic County, Cape May County, or an adjacent county
Willing and able to travel 50 to 75% in Atlantic and Cape May County and surrounding counties
Successful completion of the NJ Choice certification is a contingency of employment (exam score of 80% or higher, successful completion of State training modules, and field mentoring component)
Minimum of an Associate degree in Nursing or Diploma RN

Nice To Haves

Home care experience
Case management and/or discharge planning experience
Managed Care experience
Crisis intervention skills
Experience using personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)
NJ Choice Certification

Responsibilities

Develop, implement, support, and promote health service strategies, tactics, policies, and programs that drive the delivery of quality healthcare to our members.
Facilitate appropriate physical, behavioral health, psychosocial wrap around services using advanced clinical judgment and critical thinking skills.
Responsible for care planning, direct provider collaboration, and effective utilization of available resources in a cost-effective manner.
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).
Conduct face-to-face assessments with 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.
Coordinate and collaborate care with the member/authorized representative, PCP, and any other care team participants.
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.
Use critical thinking skills and the ability to problem solve.
Mentor new hires, once a level of proficiency has been attained in their role.