Case Manager RN - Bergen County

Hispanic Alliance for Career Enhancement; Garfield (NJ); On-site; USD 72,000 - 156,000; Full time

Job summary

An established industry player is seeking a dedicated Case Manager to join their team. This role involves implementing health service strategies and conducting assessments to ensure quality healthcare delivery. The ideal candidate will possess strong clinical judgment and communication skills, along with a commitment to advocating for members' needs. With a focus on collaboration and care planning, this position offers the chance to make a significant impact in the lives of individuals while working within a supportive and purpose-driven environment. If you are passionate about transforming healthcare and have the required qualifications, this opportunity is perfect for you.

Benefits

Affordable medical plan options

401(k) plan with matching contributions

Employee stock purchase plan

Wellness screenings

Tobacco cessation programs

Weight management programs

Confidential counseling

Financial coaching

Tuition assistance

Flexible work schedules

Qualifications

• 3+ years clinical practice experience required.
• Active RN license in NJ and NJ Choice Certification needed.

Responsibilities

• Conduct face-to-face visits and assessments for members.
• Develop care plans and coordinate services with care teams.

Skills

Clinical Judgment

Critical Thinking

Assessment Skills

Communication Skills

Problem Solving

Education

Associate Degree in Nursing

Diploma in Nursing

Tools

MS Office Suite

Electronic Health Record Systems

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 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 in order 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). Care manager may also be responsible for face-to-face assessments with 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. Successful completion of company sponsored NJ Choice Certification is a requirement for continued employment. Member assignment may include pediatric population and medically complex cases. The case manager is responsible for coordinating and collaborating care with the member/authorized representative, PCP, and any other care team participants. The case manager schedules and attends interdisciplinary meetings and advocates on the member's 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. This position requires the case manager to use critical thinking skills and the ability to problem solve. The Case Manager will also be expected to mentor new hires, once a level of proficiency has been attained in their role. 50 to 75% travel in Bergen County and surrounding counties.

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
• 50 to 75% travel in Bergen County and surrounding counties
• 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
• 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 of Associate degree or Diploma in Nursing

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$72,627.00 - $155,538.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 04/12/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.