[Hiring] Case Manager Registered Nurse @CVS Health

Role Description

This is a Field/Remote Case Manager opportunity with up to 75% field travel in Union and surrounding counties. The working 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.
• Conduct face-to-face visits in the members' homes 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) and non-MLTSS members.
• Evaluate the medical needs of the member to facilitate overall wellness and help them obtain necessary services.
• Member assignments may include pediatric population and medically complex cases.
• Schedule and attend interdisciplinary meetings and advocate on the members’ behalf for proper and safe discharge with appropriate services.
• 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.
• Coordinate and collaborate care with the member/authorized representative, PCP, and other care team participants.
• Use critical thinking skills and problem-solving abilities.
• Mentor new hires once a level of proficiency has been attained in the role.

Qualifications

• Must reside in Union County, NJ.
• 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 possess reliable transportation and be willing and able to travel 75% of the time in Hudson and surrounding counties in New Jersey.
• Successful completion of the NJ Choice certification is a contingency of employment.

Requirements

• LTSS experience.
• Case management and/or discharge planning experience.
• Managed Care experience.
• Medicaid and Medicare experience.
• Experience using computer, keyboard, mouse, multi-system navigation; and MS Office Suite applications (Outlook, Word, Excel, SharePoint, Teams).

Benefits

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs.
• Other resources, based on eligibility.