Case Manager, RN – Compact License

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Serve as a liaison among members, clients, families, employers, providers, insurance companies, and healthcare personnel.

• Oversee case management activities for catastrophic cases and chronically ill members/clients throughout the continuum of care.

• Engage with members/clients via phone or in-person, including at homes, workplaces, or physician offices.

• Evaluate medical and/or vocational conditions and formulate care plans.

• Facilitate condition management, wellness initiatives, medical outcomes, return-to-work strategies, and optimal functioning.

• Communicate effectively with members/clients and stakeholders, including medical providers, attorneys, employers, and insurance carriers.

• Prepare necessary case work documentation.

• Consult with internal multidisciplinary teams.

• Reach out to treating physicians or specialists regarding care and treatment plans.

• Provide educational and preventive information.

• Adhere to relevant laws, regulations, insurance-carrier guidelines, and company policies.

• Testify as needed to validate case work or reports.

• Assess member/client requirements and benefit plan eligibility using clinical tools and data.

• Create proactive action plans and monitor progress towards desired outcomes.

⛳️ Requirements

• An active and unrestricted Compact License.

• A minimum of 3 years of clinical practice experience.

• At least 2 years of experience in case management, discharge planning, and/or home health care coordination.

• Willingness to occasionally travel up to 10% within a specified geographic area for in-person case management activities.

• A minimum of 2 years of proficiency in Microsoft Word, Teams, Excel, Outlook, and PowerPoint.

• Experience working with Medicare members dealing with diabetes, congestive heart failure (CHF), chronic kidney disease (CKD), post-acute care, hospice, palliative care, and/or cardiac conditions.

• Background in managed care.

• Readiness to obtain additional state RN licenses if necessary.

• Outstanding analytical and problem-solving abilities.

• Strong communication, organizational, and interpersonal skills.

• Ability to work independently, remotely, and in the field.

• Proficient computer skills, including navigating multiple systems and efficient keyboarding capabilities.

• An Associate's Degree in Nursing (REQUIRED).

• An active and unrestricted New Jersey Registered Nurse (RN) Compact License.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources to support physical, emotional, and financial well-being.

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.