Registered Nurse Case Manager - Field in Bergen & surrounding counties, New Jersey

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Case Manager Registered Nurse – Field
Location: Bergen & Surrounding Counties, NJ
 

Position Summary 
This is a Field/Remote Case Manager opportunity with up to 75% field travel in Bergen & 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. 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.   

Fundamental Components/Job Description:  
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) and 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. 

• Member assignments may include pediatric population and medically complex cases. 
• 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. 
• The case manager is responsible for coordinating and collaborating care with the member/authorized representative, PCP, and any other care team participants. 
• This position requires the case manager to use critical thinking skills and the ability to solve problems. The Case Manager will also be expected to mentor new hires once a level of proficiency has been attained in their role.

Required Qualifications 

• Must reside in Bergen County
• 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 up to 75% of the time in Bergen & surrounding counties In New Jersey. Mileage is reimbursed per our company expense reimbursement policy
• Successful completion of the NJ Choice certification is a contingency of employment. As per NJ Division of Aging Services, Office of Community Choice Options guidance, an exam score of 80% or higher is required, along with successful completion of the State training modules, and field mentoring component.  

  
Preferred Qualifications 

• 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)

  
Education 

• Minimum associate’s degree or diploma in Nursing required

Work from Home Requirements: 

• You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and 
• A minimum download speed of 25 mbs download and 3 mbs upload. Wi-Fi and satellite internet are not permitted. 
• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS 
• Health and HIPAA guidelines and allowing for uninterrupted w