Case Manager Registered Nurse - Field Ocean and Surrounding Counties NJ

Position Summary

This is a full‑time field/work at home position requiring up to 75% travel throughout Ocean and surrounding counties in New Jersey. Work hours are Monday–Friday, 8:00 a.m.–5:00 p.m. EST. In this role, you will develop, implement, and support health service strategies, policies, and programs that promote high‑quality care for our members. These initiatives include utilization management, quality management, network management, and clinical coverage policies. The position requires advanced clinical judgment, strong critical‑thinking abilities, and the capacity to coordinate physical, behavioral, and psychosocial support services. Responsibilities include care planning, direct collaboration with providers, and effective resource utilization. Strong assessment, written documentation, and communication skills are essential.

Key Responsibilities

• Conduct face‑to‑face home visits using comprehensive assessment tools 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.

Required Qualifications

• Active, unrestricted RN license in the state of New Jersey.
• Minimum of 3 years of clinical experience in settings such as hospitals, home health, or ambulatory care.
• Residency in Ocean County or adjacent counties.
• Ability and willingness to travel up to 75% within Ocean and surrounding counties.
• Successful completion of NJ Choice Certification, including: exam score of 80% or higher, completion of state training modules, and field mentoring, as required by the NJ Division of Aging Services.

Preferred Qualifications

• Experience in case management and/or discharge planning.
• Background in managed care.
• Crisis intervention skills.

Education

Minimum of an associate degree in Nursing.

Pay

The typical pay range for this role is $66,575.00 – $142,576.00. 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.

Benefits

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.