Case Manager, Registered Nurse – LTSS

CVS Health

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

Posted 10/1/2026full-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 in-home assessments, developing person-centered care plans, and navigating Medicaid waiver programs while ensuring compliance with regulatory standards. Proficient in managing complex caseloads and collaborating with interdisciplinary teams to enhance member outcomes.

Highest-signal resume keywords

Registered Nurse (RN) LicenseCase Management ExperienceLong-Term Services and Supports (LTSS)Clinical Assessment SkillsMedicaid Waiver Knowledge

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Nursing ExperienceIn-Home AssessmentsPerson-Centered Service PlansSocial Determinants of HealthElectronic Medical RecordsManaged Care ExperienceRegulatory ComplianceCritical Thinking SkillsHigh-Risk Caseload ManagementCommunity Resource Navigation

Soft Skills

Excellent Communication SkillsMember Engagement SkillsIndependent Decision-MakingAbility to Work Independently

Tools & Technologies

Care Management PlatformsMS WordMS ExcelMS OutlookMS PowerPoint

Certifications & Qualifications

Registered Nurse (RN) LicenseCertified Case Manager (CCM)

Industry Keywords

MedicaidMedicareHome HealthHospiceCommunity-Based ServicesWaiver ProgramsInterdisciplinary Team MeetingsHealth Plan EnvironmentMichigan Medicaid RegulationsLong-Term Care

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 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
Travel 25–50% within assigned counties for in-home field visits
Work remotely with a dedicated workspace free of interruptions during standard business hours

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
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
Certified Case Manager (CCM) or willingness to obtain within 2 years

Benefits

Comp & perks

No evenings, weekends, or major holidays
4 day/10-hour schedule available after training
Medical, dental, and 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