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 Summary
This is a full-time telework position.
Standard business hours: 8:00 AM – 5:00 PM, Monday through Friday, with some flexibility required to accommodate members’ needs.
Preferred state of residence: Florida, District of Columbia, Maryland, South Carolina, Tennessee, Mississippi, and/ or Virginia
Nurse Case Manager, Licensed Practical Nurse (LPN) is responsible for telephonically assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.
Through the use of clinical tools and information/data review, conducts an evaluation of member’s needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans.
Responsibilities
The Transition of Care Coach is responsible for care coordination of our members who are experiencing a significant change in health status which has resulted in the necessity of an emergency department visit, inpatient, skilled nursing, or rehabilitative stay. Under the direction of a Registered/Licensed RN, the TOC Coach ensures the member experiences a seamless transition to their next care setting and facilitates post-discharge goal attainment by:
- Hospice experience and understanding the complexities of End Of Life Care
- Complete post-discharge questionnaire, which may be market specific.
- Ensures the member has filled/received their medication(s) and has an understanding on how to take their ordered medications.
- Benefit education
- Monitor members in low CM level for alerts or changes in condition to be transitioned back to RN.
- Complete post discharge call and required assessments (RAP), medication reconciliation (if within scope of practice), fall assessment if fall risk identified.
- Complete inpatient confinement calls and monitoring for discharge
Management of warm transfers form concierge and engagement hub
- Provides clinical assistance to determine appropriate services and supports due to member’s health needs (including but not limited to: Coordination with PCP and Specialty providers, Condition Management information and education, Medication management, Community Resources and supports)
- Evaluation of health and social indicators
- Identifies and engages barriers to achieving optimal member health.
- Uses discretion to apply strategies to reduce member risk.
- Facilitates overall care coordination with the care team to ensure member achieves optimal wellness within the confines of the member’s condition(s) and abilities to self-manage.
- Coordinates post-discharge meal delivery, assists with securing DME, and helps to ensure timely physician follow-up.
- Understands Payer/Plan benefits, policies, procedures, and can articulate them effectively to providers, members, and other key personnel.
Our TOC Coaches are frontline advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and eligibility status. Focus assessments and/or questionnaires are designed to use a holistic approach to identify the need for a referral to clinical resources for assistance in functionality.
Additional responsibilities to include but not limited to the following:
- Responsible for completing outreach cadence calls and post-discharge questionnaires within required compliance driven timelines
- Facilitates Interdisciplinary Care Team Meetings with Social Services, Care -Management, PCP and other key players to discuss service needs and support safe transitions
- Follows members identified as inpatient in hospitals (whether planned or unplanned admission) and then throughout the subsequent care continuum until member can return to prior level of functioning in the community
- Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department Utilization and 30-day hospital readmissions
Required Experience
- 2 years LPN nursing experience
- Unrestricted and active Compact LPN/LVN licensure
- Hospice experience and understanding the complexities of End Of Life Care
Preferred Experience
- 3 years LPN nursing experience
- Self-motivated, energetic, detail-oriented, highly organized, tech-savvy Licensed Practical Nurses
- Discharge planning
- Advanced proficiency in Microsoft Word, Excel, and Outlook
- Ability to multitask, prioritize, and effectively adapt to a fast-paced changing environment while providing outstanding care.
- Effective verbal and written communication skills
- Bilingual
- Associate’s Degree, Bachelor’s Degree
Education
High School Diploma or equivalent GED, Licensed Practical Nurse
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The Typical Pay Range For This Role Is
$21.10 – $43.78
This 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 People
We 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.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 06/06/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.