Field-Based RN Case Manager: Home Health Care

4004 Aetna Medicaid Administrators; New Jersey; On-site; USD 67,000 - 143,000; Full time

Job summary

CVS Health is seeking a Case Manager Registered Nurse to join field-based work in Mercer County, NJ, with up to 75% travel. The role focuses on developing and implementing health service strategies, policies, and programs to promote high‑quality member care, including utilization and quality management.

You will coordinate with care teams, conduct assessments, and ensure documentation is accurate in the EHR. An NJ RN license and NJ Choice Certification are required.

Qualifications

• Active, unrestricted RN license in New Jersey.
• Minimum of 3 years of clinical experience in hospitals, home health, or ambulatory care.
• Residency in Mercer County, NJ.
• Willingness to travel up to 75% of the time; mileage reimbursed.

Responsibilities

• Conduct face-to-face home visits for members enrolled in Managed Long‑Term Services and Supports (MLTSS) and/or Dual Special Needs Programs (D‑SNP/FIDE).
• Perform in-person assessments for non‑MLTSS members to determine medical needs and support appropriate service referrals (e.g., adult medical daycare, pediatric medical daycare, personal care assistant services, nursing facility custodial care, Personal Preference Program, and MLTSS enrollment).
• Successfully complete and maintain NJ Choice Certification (required for continued employment).
• Work with diverse populations, including pediatric and medically complex members.
• Coordinate and collaborate with members, authorized representatives, primary care providers, and interdisciplinary care teams.
• Schedule and participate in interdisciplinary meetings, advocating for members to ensure safe transitions and appropriate services.
• Develop individualized care plans and authorize services within MLTSS/FIDE program benefits in a cost‑effective manner.
• Document all assessments, interactions, and care planning activities accurately and in a timely manner in the electronic health record.
• Utilize strong critical‑thinking and problem‑solving skills in daily work.
• Mentor new staff once appropriate proficiency has been achieved.

Skills

RN license

Clinical experience

Travel readiness

Education

Associate degree in Nursing

Job description

CVS Health is seeking a Case Manager Registered Nurse to join field-based work in Mercer County, NJ, with up to 75% travel. The role focuses on developing and implementing health service strategies, policies, and programs to promote high‑quality member care, including utilization and quality management.

You will coordinate with care teams, conduct assessments, and ensure documentation is accurate in the EHR. An NJ RN license and NJ Choice Certification are required.