Transition of Care CM - Registered Nurse at CVS Health

Oklahoma City, Oklahoma, United States

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Not SpecifiedCompensation

Mid-level (3 to 4 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

Registered Nurse (RN) licensure
Ability to work in OKC or Tulsa metro areas (hybrid position)
Knowledge of CMS, state-specific, and NCQA compliance criteria related to Transitions of Care
Clinical assessment skills, including post-ED visit or observation stay evaluation, medical record review, medication reconciliation, and triage for follow-up care

Responsibilities

Manage members through transitions of care, either face-to-face in facilities or telephonically, within a defined geographical area and care setting
Advocate for the member throughout the care continuum to ensure access to resources and resolution of barriers to care
Identify opportunities for improved program workflows, increased internal/external partnerships, and higher quality member care
Maintain real-time and accurate records of member status through care transitions in CVS Health’s internal inpatient platform
Adhere to CMS, state-specific, and NCQA compliance criteria related to Transitions of Care
Evaluate patient status post-ED visit or observation stay through clinical assessment and medical record review
Triage to determine appropriate follow-up care and next steps, including reviewing medication lists and scheduling follow-up appointments
Engage directly with inpatient physicians, case managers, medical directors, and hospitalists to facilitate safe and timely discharge, appropriate follow-up care, and next steps
Coordinate with the Utilization Management team to review medical and payer records, ensure appropriate length of stay, and identify barriers to discharge
Assist Utilization Management team with access to external medical record information when needed
Establish relationships and ensure patient/family are informed of member condition, plan of care, discharge plan, instructions, medication reconciliation, Utilization Management determinations, financial information, potential LTC transition, and importance of timely PCP follow-up
Conduct structured clinical assessment to identify post-discharge needs (e.g., medications, specialist appointments, home health, DME, caregiver support, social determinants of health)
Follow program procedures for documenting and tracking transitions interventions
Address identified post-discharge needs directly or via collaboration with other team members
Communicate and coordinate with internal stakeholders to identify needs

Skills

Registered Nurse

Case Management

Transitions of Care

Discharge Planning

Patient Advocacy

Care Coordination

Interdisciplinary Collaboration

Telephonic Care

Readmission Prevention

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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