Registered Nurse – Transition of Care
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Job Description
Registered Nurse coordinating transitions, medications, and care plans for CVS Health’s complex Illinois Medicaid and Medicare members. Reducing readmissions through virtual interdisciplinary care.
Responsibilities:
- 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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