Transition of Care Associate

This is a fully remote position, open to applicants in Pennsylvania.

📋 Description

• Complete post-discharge questionnaires and conduct outreach cadence calls within mandated compliance timelines.

• Deliver comprehensive discharge planning and facilitate smooth transitions to subsequent care settings.

• Ensure that members obtain their medications and comprehend proper usage.

• Offer benefit education and clinical support for available services and resources.

• Manage prior authorizations, communication between PCP and specialty providers, condition management, medication oversight, and community resources.

• Assess health and social indicators and identify obstacles to optimal member health.

• Implement strategies to mitigate member risk.

• Present cases during multidisciplinary case conferences.

• Collaborate with the care team to promote optimal wellness and self-management.

• Organize post-discharge meal delivery, secure durable medical equipment (DME), and ensure timely follow-up with physicians.

• Clarify payer and plan benefits, policies, and procedures to providers, members, and essential personnel.

• Update care plans in response to changes in condition or behavioral health status.

• Utilize reporting to assess utilization and decrease Emergency Department visits and 30-day hospital readmissions.

• Support members from inpatient admission through their care continuum until they return to prior community functioning.

• Coordinate interdisciplinary care team meetings involving Social Services, Care Management, PCPs, and other key participants.

• Review prior claims to evaluate their impact on case management and eligibility status.

• Conduct holistic assessments and use questionnaires to identify referrals to clinical functionality resources.

⛳️ Requirements

• Minimum 2 years of work experience.

• Active LPN/LVN License in good standing without restrictions required.

• Experience in discharge planning.

• Advanced skills in Microsoft Word, Excel, and Outlook.

• Capability to multitask, prioritize, and adapt effectively in a fast-paced, changing environment while delivering exceptional care.

• Strong verbal and written communication abilities.

• Associate's Degree required.

• Bilingual candidates preferred.

• Compact Licensure preferred.

• Bachelor's Degree preferred.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources supporting physical, emotional, and financial well-being, based on eligibility.