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We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. This is a full‑time field/work at home position requiring up to 75% travel throughout Middlesex and Mercer counties in New Jersey. Work hours are Monday–Friday, 8:00 a.m.–5:00 p.m. EST. In this role, you will develop, implement, and support health service strategies, policies, and programs that promote high‑quality care for our members. These initiatives include utilization management, quality management, network management, and clinical coverage policies. The position requires advanced clinical judgment, strong critical‑thinking abilities, and the capacity to coordinate physical, behavioral, and psychosocial support services. Responsibilities include care planning, direct collaboration with providers, and effective resource utilization. Strong assessment, written documentation, and communication skills are essential.
Job Responsibility:
Conduct face‑to‑face home visits using comprehensive assessment tools for members enrolled in Managed Long‑Term Services and Supports (MLTSS) and/or Dual Special Needs Programs (D‑SNP/FIDE)
Perform in‑person assessments for non‑MLTSS members to determine medical needs and support appropriate service referrals
Work with diverse populations, including pediatric and medically complex members
Coordinate and collaborate with members, authorized representatives, primary care providers, and interdisciplinary care teams
Schedule and participate in interdisciplinary meetings, advocating for members to ensure safe transitions and appropriate services
Develop individualized care plans and authorize services within MLTSS/FIDE program benefits in a cost‑effective manner
Document all assessments, interactions, and care planning activities accurately and in a timely manner in the electronic health record
Utilize strong critical‑thinking and problem‑solving skills in daily work
Mentor new staff once appropriate proficiency has been achieved
Requirements:
Active, unrestricted RN license in the state of New Jersey
Minimum of 3 years of clinical experience in settings such as hospitals, home health, or ambulatory care
Residency in Middlesex and Mercer County, NJ
Ability and willingness to travel up to 75% within Middlesex and Mercer Counties
Successful completion of NJ Choice Certification, including: Exam score of 80% or higher
Completion of state training modules
Field mentoring, as required by the NJ Division of Aging Services
Minimum of an associate degree in Nursing
Nice to have:
Experience in case management and/or discharge planning
Background in managed care
Crisis intervention skills
What we offer:
Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access
CVS Health bonus, commission or short-term incentive program