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An established industry player is seeking a Clinical Case Manager to join their team in transforming healthcare delivery. This role offers the opportunity to work flexibly from home while traveling to provide essential services in Monmouth and Ocean counties. You will be responsible for developing and implementing health service strategies, conducting comprehensive assessments, and collaborating with care teams to ensure members receive the support they need. With a focus on quality and compassionate care, this position allows you to make a significant impact in the lives of individuals and communities. If you are passionate about behavioral health and looking to make a difference, this is the perfect opportunity for you.
Pay: $72,627.00 - $155,538.00 / year
Location: Oakhurst, New Jersey
Employment type: Full-Time
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 work from home flexible position with up to 75% travel requirements throughout Monmouth, Ocean, and surrounding counties, New Jersey.
Standard working hours: Monday – Friday, 8-5 pm EST
Job Description:
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, and 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 Clinical Case Manager BH is responsible for conducting face-to-face visits using comprehensive assessments of members enrolled in Managed Long-Term Services and Supports program (MLTSS) and/or Dual Special Needs Program (D-SNP/ FIDE). Care managers 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. The care manager is responsible for coordinating and collaborating care with the member/authorized representative, PCP, and any other care team participant. The care manager will attend interdisciplinary meetings and advocate on the member's behalf. The care manager works with the member and care team to develop a care plan and will authorize services within the MLTSS/ FIDE benefit. The care manager will also work with the member and care team to coordinate and assist with community resources. The care manager is responsible for documenting accurately and timely in the electronic health record. This position requires the care manager to use critical thinking and be able to problem-solve any issues related to assigned membership. While this position is tele-work, the care manager must work normal business hours. 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 Monmouth, Ocean, and surrounding counties.
Required Qualifications:
Preferred Qualifications:
Education:
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: 04/11/2025.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevent them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work. CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation, or other services through ColleagueRelations@CVSHealth.com. If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.
At CVS Health, we share a clear purpose: helping people on their path to better health. Through our health services, plans, and community pharmacists, we’re pioneering a bold new approach to total health. Making quality care more affordable, accessible, simple, and seamless, to not only help people get well but help them stay well in body, mind, and spirit.