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Position Summary

This is a full-time field-based teleworker opportunity in Oklahoma with up to 50% of travel required in Oklahoma County.

Qualified candidates preferably will reside within Oklahoma county.

The Case Manager, RN, for Transitions of Care (CMRN TOC) utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member transitions. The CM RN TOC leverages case management tools, such as assessment and care planning, direct provider coordination/collaboration, and coordination of wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. 

Fundamental Components:

• 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.
• 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/services.
• Analyzes utilization, self-report, and clinical data available to consolidate information and begin 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.
• Application and/or interpretation of 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 programs as needed to overcome barriers to meeting goals and objectives.
• Presents cases at case conferences to obtain 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.
• Ability to speak to 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 member 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.

Required Qualifications

• Must reside in Oklahoma
• RN with current unrestricted Oklahoma state licensure
• 3+ years of clinical practice experience (e.g. hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility)
• 2+ years of demonstrated experience with personal computer, keyboard navigation, and MS Office Suite applications (Teams, Outlook, Word, Excel, SharePoint, etc.)
• Must possess reliable transportation and be willing and able to travel in Oklahoma County up to 50% of the time. Mileage is reimbursed per our company expense reimbursement policy.
• Willing and able to provide on-call CM coverage for nights and weekends on a rotational schedule as required by the State regulatory agency.

Preferred Qualifications

• Managed care/utilization review experience
• Case management in an integrated model
• Discharge planning experience
• Experience providing care to American Indian/Indigenous American/Native American populations

Education

• Minimum of Associate's degree or diploma nursing degree required
• BSN degree preferred

Pay Range

The typical pay range for this role is:

$54,095.60 - $116,760.80

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. 
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 09/30/2024

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.