Transition of Care Associate, Licensed Practical Nurse, CVS Health

CVS Health

Location:
United States

Category:
Nursing

Contract Type:
Employment contract

Salary:

22.40 - 53.53 USD / Hour

Save Job

Apply Position

Job Description:

The Transition of Care Coach is responsible for care coordination of members experiencing a significant change in health status resulting from emergency department visits, inpatient, skilled nursing, or rehabilitative stays. Under RN direction, ensures seamless transition to next care setting and facilitates post-discharge goal attainment.

Job Responsibility:

Complete post-discharge questionnaire
Ensure member has filled/received medications and understands how to take them
Benefit education
Monitor members in low CM level for alerts or changes in condition
Complete post discharge call and required assessments (RAP)
Medication reconciliation (if within scope of practice)
Complete fall assessment if fall risk identified
Complete inpatient confinement calls and monitoring for discharge
Management of warm transfers from concierge and engagement hub
Provides clinical assistance to determine appropriate services 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
Coordinates post-discharge meal delivery, assists with securing DME, and helps ensure timely physician follow-up
Understands Payer/Plan benefits, policies, procedures
Responsible for completing outreach cadence calls and post-discharge questionnaires within required compliance timelines
Utilizes weekly and daily reporting to identify utilization for reducing Emergency Department Utilization and 30-day hospital readmissions
Follows members identified as inpatient in hospitals throughout subsequent care continuum
Facilitates Interdisciplinary Care Team Meetings with Social Services, Care Management, PCP and other key players

Requirements:

1 year of advanced proficiency in Microsoft Word, Excel, and Outlook
Active and unrestricted Licensed Practical Nurse (LPN) in NY or PA
High School Diploma or equivalent GED plus Licensed Practical Nurse

Nice to have:

Ability to multitask, prioritize, and effectively adapt to a fast-paced changing environment while providing outstanding care
Effective verbal and written communication skills
Bilingual (English/Spanish)
Home Health experience
Associate's Degree and/or Bachelor's Degree

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
Wellness screenings
Tobacco cessation programs
Weight management programs
Confidential counseling
Financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
September 07, 2025

Expiration:
September 26, 2025

Employment Type:

Fulltime

Work Type:

Remote work

View All Jobs In This Company

Job Link Share:

Transition of Care Associate, Licensed Practical Nurse