Transition of Care – Registered Nurse

Job not on LinkedIn

🔥 10 minutes ago

🌽 Illinois – Remote

🌽 Illinois – Remote

💵 $66.6k - $142.6k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 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 address barriers to optimal member health • Apply strategies to reduce member risk • Lead and coordinate Interdisciplinary Care Team meetings to develop and implement Individualized Care Plans • Coordinate care with interdisciplinary teams to support optimal member wellness • Coordinate post-discharge meal delivery, secure durable medical equipment, and ensure timely physician follow-up • Educate members and caregivers about care plans, medications, and community resources • Explain payer and plan benefits, policies, and procedures to providers, members, and personnel • Update care plans based on changes in condition or behavioral health status • Review prior claims for potential impacts on case management and eligibility • Complete outreach calls and post-discharge questionnaires within compliance timelines • Schedule follow-up appointments and complete medication reconciliation • Use weekly and daily 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 care team meetings with Social Services, Care Management, PCPs, and other stakeholders • Ensure compliance with state and federal regulations, including NCQA standards

🎯 Requirements

• Active and unrestricted Registered Nurse (RN) License in Illinois or willingness to obtain • 3+ years of clinical practice experience • 1+ year of experience in care coordination or working with high-risk populations • Proficiency 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) • Certified Case Manager preferred • 3+ years of 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 • Excellent analytical and problem-solving skills preferred • Effective communication, organizational, and interpersonal skills preferred • Ability to work independently, multitask, prioritize, and adapt to a fast-paced changing environment preferred • Must comply with state and federal regulations, including NCQA standards

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • CVS Health bonus, commission or short-term incentive program • Comprehensive benefits package supporting physical, emotional, and financial well-being • Remote work from home