Case Manager, Registered Nurse – LTSS

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🔥 0 minutes ago

🚗 Michigan – Remote

🚗 Michigan – Remote

💵 $60.5k - $129.6k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Conduct comprehensive in-home LTSS assessments to determine eligibility for waiver and community-based services. • Complete and submit required waiver documentation in accordance with state Medicaid and health plan guidelines. • Develop and implement individualized, person-centered plans of care addressing medical, behavioral, functional, and social determinant needs. • Apply clinical judgment to identify risk factors, prevent avoidable hospitalizations, and reduce barriers to care. • Coordinate services across interdisciplinary teams including providers, home health agencies, behavioral health, and community organizations. • Review claims data, clinical records, and assessment tools to evaluate member needs and benefit utilization. • Monitor member progress and reassess needs based on changes in condition or level of care. • Present cases at interdisciplinary team (ICT) meetings and collaborate with supervisors and stakeholders to ensure goal attainment. • Ensure compliance with Medicaid waiver requirements, CMS regulations, state LTSS guidelines, and company policies. • Document all case management activities in accordance with regulatory and accreditation standards. • Educate members and caregivers regarding benefits, services, and available community resources.

🎯 Requirements

• Active, unrestricted Registered Nurse (RN) license in the state of Michigan • Associate or Bachelor of Science in Nursing (BSN preferred) • Minimum of 2 years of clinical nursing experience • Minimum of 1 year of experience in case management, care coordination, home health, hospice, or long-term care • Experience working with Medicare, Medicaid, or dual-eligible populations • Knowledge of Long-Term Services and Supports (LTSS), home and community-based services (HCBS), and waiver programs • Experience conducting in-home assessments and developing person-centered service plans • Strong understanding of social determinants of health and community resource navigation • Ability to travel 25–50% within assigned counties, including completion of in-home field visits; reliable transportation is required • Proficient in electronic medical records and care management platforms.

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources, based on eligibility