Case Manager Registered Nurse - Field (Middlesex County, New Jersey)

About the role

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. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

This role will be work at home with 25–50% travel within Middlesex County, New Jersey (50-mile radius from applicants’ home). Standard business hours Monday–Friday 8:00 am–5:00 pm EST.

Position Summary

The ICM Case Manager develops a proactive plan of care to address identified issues to enhance the short- and long-term outcomes as well as opportunities to enhance a member’s overall wellness. You will join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. 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 determinant needs.

Our Integrated Care Management (ICM) Care Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.

Key Responsibilities

• Uses clinical tools and information/data review to conduct an evaluation of member’s needs and benefits.
• Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning.
• Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality.
• Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members.
• Collaborates with supervisor and other key stakeholders in the member’s healthcare in overcoming barriers in meeting goals and objectives; presents cases at interdisciplinary case conferences.
• Utilizes case management processes in compliance with regulatory and company policies and procedures.
• Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Remote Work Expectations

• This is a remote role with 25–50% travel required; candidates must have a dedicated workspace free of interruptions.
• Dependents must have separate care arrangements during work hours; continuous care responsibilities during shift times are not permitted.

Required Qualifications

• Minimum 3+ years of clinical practice experience.
• Must have active and unrestricted RN licensure in the state of New Jersey.
• Willing and able to travel 25–50% of their time using your own vehicle to meet members face to face in their assigned area; reliable transportation required.
• Mileage is reimbursed per the company expense reimbursement policy.
• The protection and security of our colleagues is paramount; CVS Health encourages nurses to meet with members in a public place if they feel that is more appropriate; security escort is also available.
• Must reside close to or within Middlesex County, New Jersey.

Preferred Qualifications

• Certified Case Manager preferred.
• Minimum 2+ years Care Management, Discharge Planning and/or Home Health Care Coordination experience preferred.
• Confidence working at home/independent thinker; ability to use tools to collaborate and connect with teams virtually.
• Excellent analytical and problem-solving skills.
• Effective communications, organizational, and interpersonal skills.
• Ability to work independently.
• Effective computer skills including navigating multiple systems and keyboarding.
• Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications.
• Bilingual preferred.
• NJC Certification preferred but not required.

Work From Home Requirements

• Direct/hardwired internet connection to a modem/router within 7 feet of your computer; minimum download speed of 25 Mbps download and 3 Mbps upload; WiFi and satellite internet are not permitted.
• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.
• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
• The company will provide equipment (keyboard, monitor, computer, headset, etc.).
• All new hires should provide their own workspace furniture (desk or standing desk).

Technical and Logistical Requirements

• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications simultaneously to streamline tasks and improve efficiency.
• Communication Tools: Ability to communicate on digital channels such as email, calendar invites, Teams messaging, and virtual meetings.
• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or similar (Google Workspace).
• Systems Access & Security: Ability to log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when unattended, manage strong passwords, and recognize suspicious emails or links.
• Troubleshooting & Support: Ability to resolve common technical issues independently, such as restarting an application when frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
• Future Growth: Openness to learning new skills as the workplace environment evolves.

Pay

The typical pay range for this role is $66,575.00 – $142,576.00. The actual base salary offer will depend on 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.