Case Manager, Registered Nurse – LTSS

CVS Health

. Conduct comprehensive in-home LTSS assessments to determine eligibility for waiver and community-based services .

Posted 9/18/2026full-timeRemote • Michigan • United StatesJuniorMid-Level💰 $60,522 - $129,615 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in conducting comprehensive in-home assessments and developing individualized, person-centered care plans while ensuring compliance with Medicaid and state regulations. Proficient in case management, care coordination, and navigating social determinants of health to advocate for members effectively.

Highest-signal resume keywords

Registered Nurse (RN) LicenseCase Management ExperienceLong-Term Services and Supports (LTSS) KnowledgeClinical Assessment SkillsElectronic Medical Records Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Nursing ExperienceIn-Home AssessmentsPerson-Centered Service PlansRisk Factor IdentificationClaims Data ReviewCare CoordinationRegulatory ComplianceCritical ThinkingCommunity Resource NavigationManaged Care Experience

Soft Skills

Excellent Communication SkillsMember EngagementIndependent Decision-MakingAbility to Work IndependentlyHigh-Risk Caseload Management

Tools & Technologies

Care Management PlatformsElectronic Medical RecordsMS WordMS ExcelMS OutlookMS PowerPoint

Certifications & Qualifications

Certified Case Manager (CCM)

Industry Keywords

Medicaid Waiver ProgramsHome and Community-Based Services (HCBS)Interdisciplinary Team (ICT) MeetingsSocial Determinants of HealthBilingual Skills

About the role

Key responsibilities & impact

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
Serve as a frontline advocate for members and coordinate case management activities to support overall wellness

Requirements

What you’ll need

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
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
Bilingual skills preferred
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 standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint
Dedicated workspace free of interruptions
Separate care arrangements for dependents during work hours

Benefits

Comp & perks

No evenings, weekends, or major holidays
4 day/10-hour schedule available after training
Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being
CVS Health bonus, commission or short-term incentive program in addition to base pay