Care Manager RN - Field- Cumberland

Care Manager RN – Field – Cumberland, New Jersey

CVS Health

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. As 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.

This is a work-from-home flexible position with 25‑50% travel requirements around Cumberland County, New Jersey (50‑mile radius from applicants’ home). Standard working hours Monday–Friday 8‑5 pm.

Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual‑eligible populations by utilizing best‑in‑class operating and clinical models. You can have a life‑changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. 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 medical needs and facilitate overall wellness. The ICM care manager develops a proactive plan of care to address identified issues and enhance short‑ and long‑term outcomes, as well as opportunities to enhance a member’s overall wellness.

• 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 comorbid 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, presenting 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 needs based on key questions and conversation.

• Minimum 3+ years of clinical practice experience.
• Must have active and unrestricted RN licensure in the state of NJ.
• Willing and able to travel 25‑50% of time using own vehicle to meet members face‑to‑face in assigned area. Reliable transportation required. Mileage reimbursed per company expense reimbursement policy.
• Must reside close to or within Cumberland County, New Jersey.

• 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, using 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.

Bachelor’s degree in nursing (preferred). Associate degree in nursing.

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