Transition of Care Management – Registered Nurse

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🔥 0 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $66.6k - $142.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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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 to identify member needs, including Health Related Social Needs and Social Determinants of Health • Provide comprehensive discharge planning and facilitate transitions between institutional and community settings • Ensure members have received medications and understand how to take them • Determine appropriate services and supports, including prior authorizations, provider coordination, condition management education, medication management, and community resources • Identify and engage barriers to optimal member health • Apply strategies to reduce member risk • Lead and coordinate Interdisciplinary Care Teams to develop and implement Individualized Care Plans • Coordinate care with the care team to support optimal wellness • Coordinate post-discharge meal delivery, secure durable medical equipment, and support timely physician follow-up • Educate members and caregivers on care plans, medications, and community resources • Explain payer/plan benefits, policies, and procedures to providers, members, and key personnel • Update care plans when conditions or behavioral health status change • 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 care team meetings • Ensure compliance with state and federal regulations, including NCQA standards

🎯 Requirements

• Active and unrestricted Registered Nurse (RN) License in Illinois or willing to obtain • 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 / independent thinker, using tools to collaborate and connect with teams virtually • Access to a private, dedicated space to conduct work effectively • 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 and cultural competency, community-based services and public benefits preferred • Excellent analytical and problem-solving skills preferred • Effective communications, organizational, and interpersonal skills preferred • Ability to work independently, multitask, prioritize, and adapt to a fast-paced changing environment preferred • Bilingual preferred • Associate’s Degree in Nursing (REQUIRED) • Bachelor’s Degree in Nursing (PREFERRED) • Active and unrestricted Registered Nurse (RN) License in Illinois or willing to obtain

🏖️ Benefits

• 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