Case Manager Registered Nurse - Field (Monmouth/Ocean Counties,New Jersey)

CVS Health • Toms River, NJ

1d • Remote

About The Position

The ICM Case Manager develops proactive plans of care to address identified issues, improve short- and long-term outcomes, and support members’ overall wellness. Working with Aetna’s dual-eligible population, the Case Manager serves as a frontline advocate for members enrolled in Medicare and Medicaid who may have complex health and social challenges. The role involves assessing, planning, implementing, and coordinating case management activities to evaluate medical needs and promote overall wellness. This is a work-at-home role serving Monmouth and Ocean Counties, New Jersey, with 25–50% travel within a 50-mile radius of the applicant’s home. The schedule is standard business hours, Monday through Friday, 8:00 a.m.–5:00 p.m. EST. Candidates must maintain a dedicated, interruption-free workspace and separate care arrangements for dependents during work hours.

Requirements

• At least 3 years of clinical practice experience.
• Active, unrestricted RN licensure 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 close to or within Monmouth or Ocean Counties, New Jersey.
• Associate degree required.
• Ability to maintain a dedicated workspace free of interruptions while working remotely.
• Separate care arrangements for dependents during work hours; continuous care responsibilities during shift times are not permitted.

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, including MS Word, Excel, Outlook, and PowerPoint, and some proprietary applications.
• Bilingual skills.
• Bachelor’s degree.

Responsibilities

• Use clinical tools and information or data review 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, considering all conditions, including comorbidities and multiple diagnoses that affect functionality.
• Use a holistic approach to determine whether referrals to clinical resources or other interdisciplinary team members are needed.
• Collaborate with the supervisor and other member healthcare stakeholders to overcome barriers to 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 support member engagement and understand members’ health status and needs.
• Travel to meet members face to face in the assigned area.

Benefits

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs.
• Other resources supporting physical, emotional, and financial well-being, based on eligibility.
• Eligibility for a CVS Health bonus, commission, or short-term incentive program in addition to base pay.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree