At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position SummaryThe Transition of Care (TOC) Coordinator RN utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member transitions. The TOC Coordinator RN leverages case management tools, such as assessments and care planning, direct provider coordination/ collaboration, and coordination of wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.Position Responsibilities:- Ensures safe and appropriate transition between settings by collaborating with identified points of contact at facilities, members, responsible parties, legal guardians, providers, and support networks through the interdisciplinary care team process.
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- Through the use of clinical tools and information/data review, conducts assessments of referred member's needs/eligibility and determines approach to meeting needs by evaluating available internal and external programs and services.
- Analyzes utilization, self-reported, and clinical data available to consolidate information and begins to identify comprehensive member needs.
- Follows members through their inpatient admission and continues oversight through transition from the acute setting to all other settings with the goal of reducing readmissions and increasing permanency in the community.
- Available to conduct face to face visits as necessary for high risk members.
- Coordinates care and reassess member's need 2-day, 7-day, and 14-day post-discharge timeline recommended by the Coleman Care Transitions Model.
- Ensures members transition upon discharge with adequate supervision, recommended behavioral health, physical health, pharmacy resources, and care management support.
- Educates and supports member/caregiver focusing on the seven primary areas: medication management, use of personal health record, follow up care, signs and symptoms of worsening condition, nutrition, functional needs and advance directives.
- Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues.
- Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated.
- Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.
- Applies and/or interprets applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits.
- Using a holistic approach consults with managers, medical directors and/or other program representatives as needed to overcome barriers to meeting goals and objectives.
- Presents cases at case conferences/rounds to obtain a multidisciplinary view in order to achieve optimal outcomes.
- Engages and builds continued professional relationships at network facilities.
Identifies and escalates quality of care issues through established channels.
- Communicates and collaborates with medical and behavioral health professionals to influence appropriate member care.
- Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health.
- Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
- Helps members actively and knowledgably participate with their provider in healthcare decision-making.
- In collaboration with the member and their care team develops and monitors established plans of care to meet the member's goals.
- Utilizes case management, utilization management, and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
- Reports to: Manager, Clinical Health Services.Required Qualifications:
- Must reside in Oklahoma County, OK or surrounding counties
- RN with current unrestricted Oklahoma state licensure required
- 3-5 years clinical practice experience, e.g. hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
- Pediatric Nursing experience
- 2+ years' experience using personal computer, keyboard navigation, navigating multiple systems and applications; and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.)
- Successfully complete the Behavioral Health Case Manager certification training provided through the Department of Mental Health and Substance Abuse Services within 6 month of hire datePreferred Qualifications:
- Case management in an integrated model preferred
- Managed care/utilization review experience preferred
- Discharge planning experience preferredEducation Requirements:
- Minimum Associates degree in Nursing
- BSN preferred Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:$54,095.00 - $116,760.00This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.