Registered Nurse – Transition of Care

Job not on LinkedIn

🔥 26 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $66.6k - $142.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

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

• Complete market-specific post-discharge assessments, including Health Related Social Needs and Social Determinants of Health • Provide comprehensive discharge planning and facilitate transitions between institutional and community settings • Ensure members receive and understand prescribed medications • Determine appropriate services and supports, including prior authorizations, provider coordination, condition management, medication management and community resources • Identify barriers to optimal member health and apply strategies to reduce member risk • Lead and coordinate Interdisciplinary Care Teams to develop and implement Individualized Care Plans • Coordinate care to support optimal wellness and self-management • Coordinate post-discharge meal delivery, secure durable medical equipment and arrange timely physician follow-up • Educate members and caregivers on care plans, medications and community resources • Explain payer and plan benefits, policies and procedures to providers, members and personnel • Update care plans when condition or behavioral health status changes • Complete outreach calls and post-discharge questionnaires within compliance timelines • Schedule follow-up appointments and complete medication reconciliation • Address barriers such as transportation, housing and medication access • Use daily and weekly reporting to reduce emergency department utilization and 30-day hospital readmissions • Follow members from inpatient admission through the care continuum until return to prior community functioning • Facilitate interdisciplinary meetings with Social Services, Care Management, PCPs and other stakeholders • Ensure compliance with state and federal regulations, including NCQA standards • Review prior claims and assessments to identify case management, eligibility and clinical resource needs

🎯 Requirements

• Active and unrestricted Registered Nurse (RN) License in Illinois • 3+ years of clinical practice experience • 1+ year(s) of experience in care coordination or working with high-risk populations • Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams • Confidence working at home and independently using virtual collaboration tools • Access to a private, dedicated workspace • Associate’s Degree in Nursing (REQUIRED) • Direct/hardwired internet connection to a modem/router within 7 feet of the computer • Minimum internet speed of 25 Mbps download and 3 Mbps upload • Quiet, secure, private designated home work location compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently living • Certified Case Manager (preferred) • 3+ years Care Management, Discharge Planning and/or Home Health Care Coordination experience (preferred) • Working knowledge of LTSS and HCBS options, chronic disease management, medication side effects, health equity, cultural competency, community-based services and public benefits (preferred) • Bilingual (preferred) • Comfortable setting up and using multiple monitors and navigating multiple applications • Experience with Microsoft Office 365 or similar Google Workspace applications • Ability to log in to secure systems such as VPN and EHR portals • Ability to manage strong passwords and recognize suspicious emails or links • Ability to resolve common technical issues independently

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program in addition to base pay • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • Company-provided equipment (keyboard, monitor, computer, headset, etc.) • Remote work from home • Global? No explicit global benefit stated

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