Case Manager Jobs

About The Position

Requirements

• Active and unrestricted Registered Nurse (RN) license in the applicable state.
• Minimum of 3 to 5 years of clinical nursing experience.
• Experience coordinating care for members with complex medical, behavioral health, and psychosocial needs.
• Strong knowledge of chronic disease management, care coordination, and healthcare delivery systems.
• Ability to perform clinical assessments, identify member needs, and develop comprehensive care plans.
• Excellent communication, organizational, critical thinking, and problem-solving skills.
• Proficiency in Microsoft Office applications and electronic documentation systems.
• Ability to work independently while effectively collaborating with interdisciplinary teams.
• Ability to meet work-from-home requirements, including a direct wired internet connection with minimum speeds of 25 Mbps download and 3 Mbps upload, and a quiet, secure, private designated workspace.
• Ability to work within the state and city where the colleague has confirmed they currently live.
• Comfort setting up and using multiple monitors and navigating multiple applications simultaneously.
• Ability to communicate through email, calendar invites, Teams messaging, and virtual meetings.
• Ability to use collaboration and scheduling applications such as Microsoft Office 365 or similar tools.
• Ability to access secure systems, follow computer and password security practices, and recognize suspicious emails or links.
• Ability to resolve common technical issues independently and contact IT for unresolved issues.
• Willingness to learn new skills as the workplace environment evolves.
• Current, unrestricted Registered Nurse (RN) license required.

Nice To Haves

• Certified Case Manager (CCM) certification or willingness to obtain certification.
• Experience in Managed Long-Term Care (MLTC), Medicare, Medicaid, Dual Eligible, or other managed care populations.
• Knowledge and experience with the Uniform Assessment System (UAS-NY) and person-centered service planning.
• Experience coordinating home and community-based services (HCBS), long-term services and supports (LTSS), and behavioral health services.
• Bilingual skills.
• Experience in a remote or field-based care management environment.
• Bachelor's Degree in Nursing (BSN).
• Additional certifications in Case Management, Care Coordination, Utilization Management, or related specialties.

Responsibilities

• Conduct clinical assessments of members with complex medical, behavioral health, and social needs.
• Develop and monitor person-centered care plans.
• Coordinate care across providers and community resources.
• Facilitate transitions of care.
• Identify and address barriers to health outcomes.
• Help ensure members receive medically necessary and cost-effective services.
• Collaborate with interdisciplinary teams, members, caregivers, and providers to promote quality outcomes, member satisfaction, regulatory compliance, and organizational goals.

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources, based on eligibility
• Eligible for a CVS Health bonus, commission, or short-term incentive program