Case Manager, Registered Nurse (compact New Jersey, New York, Pennsylvania)

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.\n\nAs 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.\n\nPosition Summary\n\nThis is a full-time telework position.\n\nThe hours for this position are Monday through Friday 8 : 00 AM -5 : 00 PM Eastern Standard Time (EST).\n\nHelp 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 determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country.\n\nFacilitate the delivery of appropriate benefits and / or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements, and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies.\n\nCommunity Care Case Manager use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost effective outcomes.\n\nAdditional responsibilities to include but not limited to the following : \n\n- Acts as a liaison with member / client / family, employer, provider(s), insurance companies, and healthcare personnel as appropriate.\n\n- Implements and coordinates 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 levels of care.\n\n- Interacts with members / clients telephonically\n\n- 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.\n\n- Communicates with member / client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person.\n\n- Prepares all required documentation of case work activities as appropriate.\n\nInteracts and consults with internal multidisciplinary team as indicated to help member / client maximize best health outcomes.\n\n- May make outreach to treating physician or specialists concerning course of care and treatment as appropriate.\n\n- Provides educational and prevention information for best medical outcomes.\n\n- Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources.\n\n- Conducts an evaluation of members / clients' needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information / data.\n\nUtilizes case management processes in compliance with regulatory and company policies and procedures.\n\n- Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work.\n\n- 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 member's / client's overall wellness through integration.\n\n- Monitors member / client progress toward desired outcomes through assessment and evaluation.\n\nRequired Qualifications\n\n- Active compact New Jersey, New York, Pennsylvania license\n\n- 3 years clinical practical experience preference : (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac) with Medicare members.\n\nAbility to occasionally travel within a designated geographic area for in-person case management activities as directed by Leadership and / or as business needs arise. Reliable transportation required. Mileage is reimbursed per our company expense reimbursement policy\n\n- 1 year of experience with Microsoft Office applications (MS Word, Excel, Outlook and PowerPoint)\n\nPreferred Qualifications\n\n- 2 years Case Management, Discharge Planning, and / or Home Health Care coordination experience\n\n- Certified Case Manager is preferred.\n\n- Excellent analytical and problem-solving skills\n\n- Effective communications, organizational, and interpersonal skills.\n\n- Efficient and Effective computer skills including navigating multiple systems and keyboarding\n\n- Bachelors of Science Degree in Nursing\n\nEducation\n\nAssociates Degree in Nursing\n\nAnticipated Weekly Hours\n40\n\nTime Type\nFull time\n\nPay Range\n\nThe typical pay range for this role is : \n\n$60,522.00 - $155,538.00\n\nThis 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.\n\nOur people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.\n\nGreat benefits for great people\n\nWe take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include : \n

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.\n
• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.\n
• 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.\n\nFor more information, visit https : / / jobs.cvshealth.com / us / en / benefits\n\nWe anticipate the application window for this opening will close on : 11 / 28 / 2025\n\nQualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.