Case Manager Registered Nurse - Field in Union & surrounding counties, NJ

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.

About the role

This is a Field/Remote Case Manager opportunity with up to 75% field travel in Union 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. 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.

Responsibilities

• Conduct face-to-face visits in the member’s 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) and non-MLTSS members to evaluate medical needs and facilitate overall wellness.
• Address 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.
• Manage member assignments, including pediatric populations and medically complex cases.
• Schedule and attend interdisciplinary meetings, advocating on the member’s behalf to ensure proper and safe discharge with appropriate services in place.
• Work with the member and care team to develop a care plan and authorize services in a cost-effective manner within the MLTSS/FIDE benefit.
• Document accurately and timely in the member’s electronic health record.
• Coordinate and collaborate care with the member/authorized representative, PCP, and other care team participants.
• Use critical thinking skills and problem-solving abilities to address member needs.
• Mentor new hires once proficiency in the role is attained.

Requirements

• Must reside in Union County, NJ.
• 3+ years of clinical practice experience (e.g., hospital setting, alternative care setting such as home health or ambulatory care).
• Active and unrestricted RN license in NJ.
• Reliable transportation and willingness to travel 75% of the time in Hudson and surrounding counties in New Jersey (mileage reimbursed per company policy).
• Successful completion of the NJ Choice certification is a contingency of employment (requires an exam score of 80% or higher, completion of State training modules, and field mentoring component).

Preferred Qualifications

• LTSS experience.
• Case management and/or discharge planning 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 associate’s degree or diploma in Nursing required.

Work From Home Requirements

• Direct/hardwired internet connection to a modem/router within 7 feet of your computer with a minimum download speed of 25 Mbps and upload speed of 3 Mbps (Wi-Fi and satellite internet are not permitted).
• Quiet, secure, and private designated home workspace, free from distractions, tidy, organized, and compliant with CVS Health and HIPAA guidelines.
• Work-from-home colleagues must work within the state and city where they reside.
• Company-provided equipment (keyboard, monitor, computer, headset, etc.).
• Colleague must provide their own workspace furniture (desk or standing desk).

Technical And Logistical Requirements

• Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously.
• Ability to communicate via digital channels (email, calendar invites, Teams messaging, virtual meetings).
• Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) or similar (Google Workspace).
• Ability to log in to secure systems (e.g., VPN, EHR portal), manage strong passwords, and recognize suspicious emails or links.
• Ability to resolve common technical issues independently (e.g., restarting applications, resolving internet connection issues).
• Openness to learning new skills as the workplace environment evolves.

Schedule

• Full-time, 40 hours per week.
• Monday - Friday, 8am-5pm EST.

Pay

The typical pay range for this role is $66,575.00 - $142,576.00 annually. This position is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range.

Benefits

This full-time position is eligible for a comprehensive benefits package, including:

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources.