At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Conducts routine care coordination, support, and education through the use of care management resources in order to facilitate appropriate healthcare outcomes for members. Helps implement projects, programs, and processes for Case Management. Applies practical knowledge of Case Management to administer best of class policies, procedures, and plans for the area.

A Brief Overview

Conducts routine care coordination, support, and education through the use of care management resources in order to facilitate appropriate healthcare outcomes for members. Helps implement projects, programs, and processes for Case Management. Applies practical knowledge of Case Management to administer best of class policies, procedures, and plans for the area.

What you will do

Consults with case managers, supervisors, medical directors and/or other health programs using a holistic approach, to overcome barriers to meeting goals and objectives.Presents cases at case conferences to obtain a multidisciplinary review in order to achieve optimal outcomes.Identifies and escalates quality of care issues through established channels.Demonstrates negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.Delivers influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.Assists in encouraging members to actively participate with their provider in healthcare decision-making.Conducts initial evaluations of referred members’ needs/eligibility using care management tools and recommends an approach to case resolution.Case Manage and advocate for Aetna Better Health of New Jersey DCP&P and DDD population.Assist members to close SDoH gaps by linking members to community resources and benefits such as SNAP or emergency housing.  

Required Qualifications

Must live in the Northern and Upper Central NJ, Preferably Middlesex, Union or Essex CountyAbility to travel up to 50% of time to visit Members face to face as needed anywhere in the state of New Jersey. Travel requirements are subject to shift based upon business need.Must have reliable transportation to complete Home/Community visits2 or more years’ experience working with Pediatric, Adult clients with special needs, and or behavioral health diagnosis is required1+ years experience working with clients/member’s in a medical or community setting.Demonstrated attention to detail.Computer literacy and demonstrated proficiency in order to navigate through internal/external computer systems, and MS Office Suite applications, including Excel and Teams.Highly organized, flexible and adaptable to change in a fast paced environment.

Preferred Qualifications

Various community settings not limited to members home, hospitals, doctors office’s/community. Remote work experience preferredAbility to interface with member/clients in the community or in their homes depending on the member preferenceBilingual English/SpanishCommunity Case Management or insurance/Patient advocate experience

Education

Bachelor's Degree is required, preferably in sociology, psychology or equivalent work experience as a community-based case manager/advocateMasters Degree in Sociology or Psychology, Social Work is Preferred

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$21.10 - $49.08

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 07/09/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.