Transition of Care Management – Registered Nurse

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

📋 Description

• Conduct market-specific post-discharge evaluations to determine member needs, focusing on Health Related Social Needs and Social Determinants of Health.

• Deliver thorough discharge planning and assist in transitions between institutional and community environments.

• Ensure that members have received their medications and comprehend how to use them correctly.

• Identify suitable services and supports, which include prior authorizations, provider coordination, education on condition management, medication management, and access to community resources.

• Recognize and address barriers to achieving optimal member health.

• Implement strategies aimed at minimizing member risk.

• Direct and coordinate Interdisciplinary Care Teams to create and execute Individualized Care Plans.

• Collaborate with the care team to promote optimal wellness.

• Organize post-discharge meal delivery, arrange durable medical equipment, and ensure timely follow-up with physicians.

• Provide education to members and caregivers regarding care plans, medications, and available community resources.

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

• Revise care plans when there are changes in conditions or behavioral health status.

• Conduct outreach calls and complete post-discharge surveys within compliance timelines.

• Arrange follow-up appointments and perform medication reconciliation.

• Tackle barriers such as transportation, housing, and access to medications.

• Utilize daily and weekly reporting to decrease emergency department visits and 30-day hospital readmissions.

• Follow members from inpatient admission through the entire care continuum until they return to their previous community functioning.

• Facilitate meetings for interdisciplinary care teams.

• Ensure adherence to state and federal regulations, including NCQA standards.

⛳️ Requirements

• Current and unrestricted Registered Nurse (RN) License in Illinois or willingness to obtain one.

• Minimum of 3 years of clinical practice experience.

• At least 1 year of experience in care coordination or working with high-risk populations.

• Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams.

• Confident working independently from home and skilled in using tools for virtual collaboration with teams.

• Must have access to a private, dedicated workspace to perform job duties effectively.

• Certified Case Manager is preferred.

• Preferred experience of 3+ years in Care Management, Discharge Planning, and/or Home Health Care Coordination.

• Working knowledge of LTSS and HCBS options, chronic disease management, medication side effects, health equity and cultural competency, as well as community-based services and public benefits is preferred.

• Excellent analytical and problem-solving capabilities are preferred.

• Strong communication, organizational, and interpersonal skills are preferred.

• Ability to work autonomously, multitask, prioritize, and adapt to a dynamic, fast-paced environment is preferred.

• Bilingual candidates are preferred.

• An Associate’s Degree in Nursing is REQUIRED.

• A Bachelor’s Degree in Nursing is PREFERRED.

• Current and unrestricted Registered Nurse (RN) License in Illinois or willingness to obtain one.

🏝️ Benefits

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

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

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