Transitional Care Manager, Social Worker (License Required)

Job not on LinkedIn

🔥 9 hours ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

💵 $46.6k - $101.2k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👔 Manager

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

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

• Manage patients through transitions of care, either face to face in the facility or telephonically, within a defined geographical area and care setting. • Advocate for the patient throughout the care continuum to ensure access to resources and resolution to all barriers to care. • Establish relationships and ensure patient/family are informed of patient condition, plan of care and discharge plan, all discharge instructions, medication reconciliation; rationale of Utilization Management determinations and any financial information associated with such, potential for LTC transition (if applicable) and importance of timely PCP follow-up following discharge. • Identify opportunities for improved program workflows, increased internal and external partnerships, and higher quality patient care. • Maintain real-time and accurate records of patient status through care transitions within Oak Street's internal inpatient platform. • Adhere to CMS, state specific and NCQA compliance criteria as related to Transitions of Care. • Coordinate with the Utilization Management team to review medical and payer records to ensure appropriate length of stay and identify any barriers to discharge. • Participate in regular inpatient and post-acute rounding calls with Care Navigation and Utilization Management teams to help determine patient status and appropriate discharge plan. • Assist Utilization Management team with access to external medical record information (if available) when needed to make appropriate determinations. • Collaborate with other transitions team members (e.g., Transitional Care Managers - RN and Transitional Care Coordinators) to ensure safe discharge and timely follow up. • Communicate and coordinate with internal stakeholders to identify and address patient needs (e.g., care team, social work, behavioral health, utilization management, Hard-to-Reach, Central Telehealth, etc.). • Participate in regular meetings with Oak Street Health regional leaders to coordinate program implementation and ongoing management. • Engage directly with inpatient physicians, case managers, medical directors, social workers, and SNFists (where applicable) to facilitate safe and timely discharge, appropriate follow-up care, and next steps. • Participate in initial and ongoing required training to ensure appropriate implementation of transitions activities and programming. • Follow program procedures for documenting and tracking transitions interventions. • Other duties, as assigned.

🎯 Requirements

• LSW/LCSW in PA required • Willingness to obtain cross-state licensure, as needed • Certified Case Manager (CCM) required, or willingness to obtain within 12 months of hire • Minimum of 2 years of experience in transitional social work, discharge planning, or home health • Experience in utilization management preferred • Knowledge of Medicare/Medicaid and NCQA regulatory transitions of care criteria • Exceptional communication skills and customer service orientation • Innovative and independent problem solving skills • Ability to monitor and evaluate opportunities for cost-effective care options with high-quality outcomes • Spanish-speaking preferred but not required • Access to reliable transportation with the ability to travel daily • Working knowledge of Microsoft Office Product Suite • US work authorization.

🏖️ Benefits

• Medical, dental, and vision coverage • Paid time off • Wellness programs • Retirement savings options