Case Manager, Registered Nurse - New Jersey

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
Help us elevate our patient care to a whole new level! Join our Community Care team as an industry leader in serving our members by utilizing best-in-class operating and clinical models. You can have life-changing impact on our Community Care members. Community Care is a member centric, team-delivered, community-based care management model that joins members where they are. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members' health care and social determinate needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country.

• Acts as a liaison with member/client/family/employer, provider(s), insurance companies, and healthcare personnel as appropriate.
• Implements and coordinated all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative level of care.
• Interacts with members/ clients telephonically or in person. May be required to meet with members/clients in their homes, work sites, or physician's office to provide ongoing case management services.
• Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client's appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate.
• Communicates with member/client and other stakeholders as appropriate (e.g. medical providers, attorneys, employers, and insurance carriers) telephonically or in person.
• Prepares all required documentation of case work activities as appropriate.
• Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes.
• May make outreach to treating physician or specialists concerning course of care and treatment as appropriate.
• Provides educational and prevention information for best medical outcomes.
• Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instruction required by individual insurance carriers and referral sources.
• Testifies as required to substantiate any relevant case work or reports.
• Conducts and evaluation of members/ clients' needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data.
• Utilizes care management processes in compliance with regulatory and company policies and procedures.
• Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work.
• Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes, as well as opportunities to enhance a members/clients' overall wellness through integration.
• Monitors member/clients progress toward desired outcomes through assessment and evaluation

• Candidate must reside in New Jersey
• Candidate must have an active and unrestricted New Jersey Registered Nurse (RN) Compact License
• 3+ years clinical practice experience
• 2+ years case management, discharge planning, and/or home health care coordination experience
• Ability to occasionally travel up to 10% within a designated geographic area for in-person case management activities as directed by Leadership and/or as business needs arise
• 2+ years proficiency with standard corporate software applications, including Microsoft Word, Teams, Excel, Outlook, and PowerPoint

• Experience working with Medicare members with diabetes, c ongestive heart failure (CHF), c hronic kidney disease (CKD), post-acute care, hospice, palliative care, and/or cardiac
• Managed care experience
• Willing and able to obtain additional state RN licenses (if needed)
• Excellent analytical and problem-solving skills
• Effective communications, organizational, and interpersonal skills
• Ability to work independently, remotely, and field based
• Efficient and effective computer skills including navigating multiple systems and keyboarding

• Associate's Degree in Nursing (REQUIRED)
• Bachelor's Degree in Nursing (PREFERRED)

• Candidate must have an active and unrestricted New Jersey Registered Nurse (RN) Compact License

• 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.