Case Manager, Registered Nurse – LTSS

Job not on LinkedIn

🕒 July 17

🚗 Michigan – Remote

🚗 Michigan – Remote

💵 $60.5k - $129.6k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 35%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

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 according to 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, 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 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 case management activities according to regulatory and accreditation standards • Educate members and caregivers about benefits, services, and community resources • Serve as a frontline advocate for dual-eligible Medicare and Medicaid members with complex health and social needs

🎯 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 • Dedicated workspace free of interruptions • Separate care arrangements for dependents during work hours • Certified Case Manager (CCM) or willingness to obtain within 2 years • Experience in managed care or health plan environment • Knowledge of Michigan Medicaid waiver programs and state LTSS regulations • Experience presenting cases in interdisciplinary team (ICT) settings • Strong clinical assessment and critical thinking skills • Excellent communication and member engagement skills • Ability to manage a high-risk, complex caseload • Regulatory and compliance knowledge • Independent decision-making in a remote environment • Ability to work independently • Effective computer skills, including navigating multiple systems and keyboarding • Proficiency with MS Word, Excel, Outlook, and PowerPoint • Bilingual skills preferred

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being, based on eligibility