[Remote] Transition of Care Associate at CVS Health

Georgia, Vermont, United States

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Not SpecifiedCompensation

Entry Level & New Grad, Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Health InsuranceIndustries

Requirements

Understands Payer/Plan benefits, policies, and procedures and can articulate them effectively to providers, members, and other key personnel
Ability to complete post-discharge questionnaires, which may be market specific
Knowledge of clinical assistance for services like Prior Authorizations, coordination with PCP and specialty providers, condition management, medication management, and community resources
Capability to evaluate health and social indicators, identify barriers to optimal health, and apply strategies to reduce member risk
Experience in care coordination, discharge planning, and facilitating transitions across care settings (e.g., emergency department, inpatient, skilled nursing, rehabilitative)
Ability to present cases at case conferences for multidisciplinary focus
Understanding of holistic assessments to identify referrals to clinical resources

Responsibilities

Complete post-discharge questionnaire, which may be market specific
Provide comprehensive discharge planning
Ensure the member has filled/received their medication(s) and understands how to take them
Provide benefit education
Provide clinical assistance to determine appropriate services and supports (e.g., Prior Authorizations, coordination with PCP/specialty providers, condition management, medication management, community resources)
Evaluate health and social indicators
Identify and engage barriers to achieving optimal member health and use discretion to apply strategies to reduce member risk
Present cases at case conferences for multidisciplinary focus
Facilitate overall care coordination with the care team to ensure optimal wellness
Coordinate post-discharge meal delivery, assist with securing DME, and ensure timely physician follow-up
Update the Care Plan for changes in condition or behavioral health status
Review prior claims to address potential impact on current case management and eligibility
Complete outreach cadence calls and post-discharge questionnaires within required compliance-driven timelines
Utilize weekly and daily reporting to identify utilization for reducing Emergency Department utilization and 30-day hospital readmissions
Follow members identified as inpatient (planned or unplanned) throughout the subsequent care continuum until return to prior level of functioning
Facilitate Interdisciplinary Care Team Meetings with Social Services, Care Management, PCP

Skills

Key technologies and capabilities for this role

Care CoordinationDischarge PlanningMedication ManagementBenefit EducationClinical AssistancePatient CommunicationHealth Care NavigationPost-Discharge Follow-Up

Questions & Answers

Common questions about this position

Is this a remote position or does it require office work?

This information is not specified in the job description.

What are the key responsibilities of the Transition of Care Coach?

The role involves completing post-discharge questionnaires, providing comprehensive discharge planning, ensuring medication adherence, benefit education, clinical assistance for services like prior authorizations, evaluating health and social indicators, and coordinating care including meal delivery, DME, and physician follow-ups.

What is the employment type for this position?

This is a full-time position.

What skills or knowledge are essential for success in this role?

Essential skills include compassionate communication, understanding of payer/plan benefits, policies, and procedures, ability to articulate them effectively, clinical knowledge for care coordination, and discretion in applying strategies to reduce member risk.

What is the company culture like at CVS Health?

CVS Health emphasizes building a world of health with dedicated, purpose-driven colleagues who are passionate about transforming health care in a connected, convenient, and compassionate way.

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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