Bringing our heart to every moment of your health.
Case Manager, Registered Nurse – LTSS
Location
Michigan
Posted
2 days ago
Salary
$60.5K - $129.6K / year
Seniority
Mid Level
Job Description
Case Manager, Registered Nurse – LTSS
CVS Health
• 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.
Job 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
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