CVS Health is looking for a Transition of Care Management Registered Nurse. This role ensures safe, effective, and seamless transitions of care for high-risk, medically complex, and vulnerable members enrolled in specific Medicare and Medicaid programs. You'll provide comprehensive care coordination, develop care plans, and work with an interdisciplinary team to improve health outcomes.
What You'll Do
- Complete market-specific post-discharge assessments to identify member needs, including social determinants of health.
- Provide comprehensive discharge planning and facilitate transitions between institutional and community settings.
- Ensure medication adherence and provide education to members and caregivers.
- Provide clinical assistance to determine appropriate services based on health needs.
- Identify and engage barriers to achieving optimal member health.
- Lead the Interdisciplinary Care Team to develop and implement Individualized Care Plans.
- Coordinate overall care to ensure members achieve optimal wellness.
- Coordinate post-discharge meal delivery, secure DME, and ensure timely physician follow-up.
- Articulate payer/plan benefits, policies, and procedures to providers and members.
- Update the Care Plan for any change in condition.
- Complete outreach calls and post-discharge questionnaires within required timelines.
- Schedule follow-up appointments and ensure medication reconciliation.
- Identify and address barriers to care like transportation or housing.
- Utilize reporting to identify trends to reduce Emergency Department use and 30-day hospital readmissions.
- Follow members identified as inpatient throughout the subsequent care continuum.
- Facilitate Interdisciplinary Care Team Meetings with Social Services, Care Management, and PCPs.
- Ensure compliance with state and federal regulations, including NCQA standards.
What We're Looking For
- Active and unrestricted Registered Nurse (RN) License in Illinois.
- 3+ years of clinical practice experience.
- 1+ year of experience in care coordination or with high-risk populations.
- Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, Teams).
- Confidence working independently from home, using tools to collaborate virtually.
- Access to a private, dedicated workspace.
- Associate’s Degree in Nursing (required).
Nice to Have
- Certified Case Manager certification.
- 3+ years of Care Management, Discharge Planning, and/or Home Health Care Coordination experience.
- Working knowledge of LTSS and HCBS options, chronic disease management, medication side effects, health equity, and community-based services.
- Excellent analytical, problem-solving, communication, organizational, and interpersonal skills.
- Ability to work independently, multitask, prioritize, and adapt to a fast-paced environment.
- Bilingual skills.
- Bachelor’s Degree in Nursing (preferred).
Technical Stack
- Microsoft Office Suite (Word, Excel, Outlook, OneNote, Teams)
Team & Environment
You will work with an Interdisciplinary Care Team (ICT), Social Services, Care Management, PCPs, and other key players.
Benefits & Compensation
- Compensation range: $66,575.00 - $142,576.00.
- Affordable medical plan options.
- 401(k) plan with company matching.
- Employee stock purchase plan.
- No-cost wellness screenings, tobacco cessation, and weight management programs.
- No-cost confidential counseling and financial coaching.
- Paid time off.
- Flexible work schedules.
- Family leave.
- Dependent care resources.
- Colleague assistance programs.
- Tuition assistance.
- Retiree medical access.
Work Mode
This is a remote position. Candidates must be located in Illinois.
CVS Health is passionate about transforming health care and caring for people where, when, and how they choose. We are committed to fostering a workplace where every colleague feels valued and that they belong.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all applicable laws.
