Job Description:
• Develop proactive plans of care to address identified issues and improve short- and long-term outcomes
• Assess, plan, implement, and coordinate case management activities
• Evaluate members’ medical needs and overall wellness
• Review clinical tools, information, data, and claims to evaluate member needs and benefits
• Apply clinical judgment to reduce risk factors and address complex health and social indicators
• Conduct holistic assessments covering comorbidities, multiple diagnoses, and functionality
• Determine need for referrals to clinical resources and interdisciplinary team members
• Collaborate with supervisors, healthcare stakeholders, providers, community organizations, and interdisciplinary teams
• Present cases at interdisciplinary case conferences
• Use case management processes in compliance with regulatory and company policies
• Use motivational interviewing to engage members and assess health status and needs
• Meet members face to face within the assigned Bergen/Hudson County area
Requirements:
• Minimum 3+ years of clinical practice experience
• Active and unrestricted RN licensure in New Jersey required
• Willingness and ability to travel 25–50% using own vehicle for face-to-face member visits
• Reliable transportation required
• Must reside close to or within Bergen/Hudson County, New Jersey
• Dedicated workspace free of interruptions
• Separate dependent care arrangements during work hours
• Certified Case Manager preferred
• Minimum 2+ years of care management, discharge planning, and/or home health care coordination experience preferred
• Ability to work independently and think independently from home
• Excellent analytical and problem-solving skills
• Effective communication, organizational, and interpersonal skills
• Effective computer skills, including navigating multiple systems and keyboarding
• Proficiency with MS Word, Excel, Outlook, PowerPoint, and proprietary applications
• Bilingual ability preferred
• Associate’s degree required
• Bachelor’s degree preferred
Benefits:
• CVS Health bonus, commission or short-term incentive program in addition to base pay
• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources supporting physical, emotional, and financial well-being
• Mileage reimbursement according to company expense reimbursement policy
• Security escort available if needed