Case Manager Registered Nurse - Field - Must live in Bergen County New Jersey

The Muse; Fair Lawn (NJ); Remote; USD 72,000 - 156,000; Full time

Job summary

A leading health solutions company offers a remote Case Manager role with significant travel needs in Bergen County. You will work on care planning and assessments, ensuring high-quality healthcare delivery. Candidates must have an active NJ RN license and relevant clinical experience. This role emphasizes critical thinking and care coordination and comes with a competitive salary and comprehensive benefits.

Benefits

Medical benefits

401(k) plan

Paid time off

Flexible schedules

Tuition assistance

Qualifications

• 3+ years of clinical practice in hospital or home health.
• Active RN license in NJ required.
• Completion of NJ Choice certification needed.

Responsibilities

• Conduct face-to-face visits and comprehensive assessments.
• Develop care plans and collaborate with providers.
• Authorize services and document in health records.

Skills

Assessment

Critical Thinking

Communication

Education

Associate degree or diploma in Nursing

Tools

MS Office Suite

Job description

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose-driven colleagues — caring for people where, when, and how they choose in a way that is uniquely more connected, more convenient, and more compassionate. And we do it all with heart, each and every day.

Position Summary

Signing bonus potential up to $10,000 for eligible external candidates who possess NJ Choice Certification. This is a remote Case Manager opportunity with 50 to 75% field travel in Bergen County and surrounding counties. The working schedule is Monday - Friday, 8 am - 5 pm EST.

Develop, implement, support, and promote health service strategies, tactics, policies, and programs that drive the delivery of quality healthcare to our members. The role involves 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, and psychosocial wrap-around services. Responsibilities include care planning, direct provider collaboration, and effective resource utilization in a cost-effective manner. Strong assessment, writing, and communication skills are essential.

Fundamental Components/Job Description

The Case Manager conducts face-to-face visits in members' homes using comprehensive assessment tools for members enrolled in Managed Long-Term Services and Supports (MLTSS) and/or Dual Special Needs Program (D-SNP/FIDE). They may also assess non-MLTSS members to evaluate medical needs, facilitate overall wellness, and help obtain necessary services such as adult or pediatric medical daycare, personal care assistance, nursing facility requests, and program enrollments. Completion of NJ Choice Certification is required for employment. The role may involve working with pediatric and medically complex cases, coordinating care with members, authorized representatives, PCPs, and other care team members. The case manager advocates for proper and safe discharge planning, develops care plans, and authorizes services within the MLTSS/FIDE benefits, documenting accurately and timely in electronic health records. Critical thinking and problem-solving skills are necessary, and mentorship of new hires is expected once proficiency is attained. The position involves 50 to 75% travel in Bergen County and surrounding areas.

Required Qualifications

• Must reside in Bergen County
• 3+ years of clinical practice experience (e.g., hospital, home health, ambulatory care)
• Active and Unrestricted RN license in NJ
• 50 to 75% travel in Bergen County and surrounding counties
• Successful completion of NJ Choice certification (exam score of 80%+, completion of training modules, and field mentoring)
• Own transportation is required

Preferred Qualifications

• Home Health and/or Hospice experience
• LTSS experience
• Case management and discharge planning experience
• Managed Care experience
• Medicaid and Medicare experience
• Proficiency with computer systems and MS Office Suite

Education

• Minimum Associate degree or diploma in Nursing

Additional Details

Weekly Hours: 40

Time Type: Full time

Pay Range: $72,627.00 - $155,538.00, commensurate with experience and other factors. The role may include bonuses and incentives.

Benefits

• Medical, 401(k), stock purchase plan
• Wellness programs, counseling, financial coaching
• Paid time off, flexible schedules, family leave, dependent care resources, tuition assistance, retiree medical, and more

For more details, visit CVS Health Benefits. The application window closes on 06/30/2025. Qualified applicants with arrest or conviction records will be considered in accordance with applicable laws.