Case Manager Registered Nurse

Case Manager Registered Nurse – Field

Location: Hudson & Surrounding Counties, NJ

Position Summary

This is a Field/Remote Case Manager opportunity with up to 75% field travel in Hudson County and surrounding counties.

The working schedule is Monday - Friday 8am-5pm EST.

Develop, implement, support, and promote health service strategies, tactics, policies, and programs that drive the delivery of quality healthcare to our members. Health service strategies, policies, and programs are comprised of utilization management, quality management, network management, clinical coverage and policies. The position requires advanced clinical judgment and critical thinking skills to facilitate appropriate physical, behavioral health, psychosocial wrap around services. The care manager will be responsible for care planning, direct provider collaboration, and effective utilization of available resources in a cost-effective manner. Strong assessment, writing and communication skills are required.

Fundamental Components/Job Description:

The Case Manager is responsible for conducting face to face visits in the members home utilizing comprehensive assessment tools for members enrolled in Managed Long-Term Services and Supports program (MLTSS) and/or Dual Special Needs Program (D-SNP/ FIDE) and non-MLTSS members to evaluate the medical needs of the member to facilitate the member’s overall wellness and help them obtain the services they need to thrive by addressing requests for services such as adult medical daycare, pediatric medical daycare, personal care assistant, nursing facility custodial requests, personal preference program and MLTSS program enrollment.
Member assignments may include pediatric population and medically complex cases.
The case manager schedules and attends interdisciplinary meetings and advocates on the members’ behalf to ensure proper and safe discharge with appropriate services in place.
The case manager works with the member and care team to develop a care plan and authorizes services in a cost-effective manner within the MLTSS/ FIDE benefit.
The care manager is responsible for documenting accurately and timely in the member’s electronic health record.
The case manager is responsible for coordinating and collaborating care with the member/authorized representative, PCP, and any other care team participants.
This position requires the case manager to use critical thinking skills and the ability to solve problems. The Case Manager will also be expected to mentor new hires once a level of proficiency has been attained in their role.
Required Qualifications

Must reside in Hudson &/or Surrounding Counties in New Jersey
3+ years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care
Active and Unrestricted RN license in NJ
Must possess reliable transportation and be willing and able to travel up to 75% of the time in Hudson and surrounding counties In New Jersey. Mileage is reimbursed per our company expense reimbursement policy
Successful completion of the NJ Choice certification is a contingency of employment. As per NJ Division of Aging Services, Office of Community Choice Options guidance, an exam score of 80% or higher is required, along with successful completion of the State training modules, and field mentoring component.

Preferred Qualifications

LTSS experience
Case management and/or discharge planning experience
Managed Care experience
Medicaid and Medicare experience
Experience using computer, keyboard, mouse, multi-system navigation; and MS Office Suite applications (Outlook, Word, Excel, SharePoint, Teams)

Education

Minimum associate’s degree or diploma in Nursing required
Work from Home Requirements:

You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and
A minimum download speed of 25 mbs download and 3 mbs upload. Wi-Fi and satellite internet are not permitted.
A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS
Health and HIPAA guidelines and allowing for uninterrupted work during work hours.
Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.
The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own
workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).
If hired, you will commit to obtaining required internet speeds and adhere to all Work from Home requirements.
Technical and Logistical Requirements:

Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications
simultaneously to streamline tasks and improve efficiency.
Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and
virtual meetings.
Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or
similar (Google Workspace).
Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when
unattended, manage strong passwords, and recognize suspicious emails or links.
Troubleshooting & Support: Ability to resolve common technical issues independently, such as restarting an application when
frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.
Future Growth: Openness to learning new skills in the future as the workplace environment evolves
Anticipated Weekly Hours

40
Time Type

Full time
Pay Range

The typical pay range for this role is:

$66,575.00 - $142,576.00