Case Manager RN - Mercer/Burlington Counties

CVS Health; Burlington (NJ); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading health solutions company is seeking a Case Manager RN for the Mercer/Burlington Counties area. This full-time remote role involves developing care plans, conducting assessments, and collaborating with healthcare teams to ensure quality service delivery. The position requires strong clinical judgment, communication skills, and the ability to manage complex cases effectively. Successful candidates will also mentor new hires and ensure compliance with health service policies.

Qualifications

• Strong assessment, writing, and communication skills required.
• Successful completion of NJ Choice Certification is required.

Responsibilities

• Developing and implementing health service strategies and policies.
• Conducting face-to-face visits in members' homes for assessments.
• Coordinating care plans and authorizing services within MLTSS/FIDE.

Skills

Assessment

Communication

Critical Thinking

Problem Solving

Education

NJ Choice Certification

Job description

Join to apply for the Case Manager RN - Mercer/Burlington Counties role at CVS Health.

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. This is a full-time remote opportunity with 50 to 75% travel in Mercer/Burlington County and surrounding counties. The schedule is Monday - Friday, 8 am-5 pm EST.

The role involves developing, implementing, supporting, and promoting health service strategies, policies, and programs that drive the delivery of quality healthcare. Responsibilities include 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. The Case Manager conducts face-to-face visits in members' homes, utilizing 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 evaluate the medical needs of non-MLTSS members to facilitate overall wellness and help obtain necessary services, such as adult or pediatric medical daycare, personal care assistance, nursing facility requests, and program enrollments.

Successful completion of the NJ Choice Certification is required for continued employment. Member assignments may include pediatric and medically complex cases. The case manager coordinates and collaborates with members, authorized representatives, PCPs, and other care team members, scheduling and attending interdisciplinary meetings, advocating for safe discharges, and ensuring proper services are in place.

The case manager develops care plans and authorizes services within the MLTSS/FIDE benefits, documenting accurately and timely in the electronic health record. Critical thinking and problem-solving skills are essential. The role also involves mentoring new hires once proficiency is attained.

Seniority level

• Mid-Senior level

Employment type

• Full-time

Job function

• Health Care Provider

Industries

• Hospitals and Health Care