Transition of Care Coordinator, CVS Health

CVS Health

Location:
United States, Oklahoma City

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

54095.00 - 116760.00 USD / Year

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Job Description:

The Transition of Care Coordinator Behavioral Health utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member behavioral health transitions. The TOC Coordinator BH leverages case management tools, such as assessments and care planning, direct provider coordination/collaboration, and coordination of wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.

Job Responsibility:

Ensures safe and appropriate transitions 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 and services
Analyzes utilization, self-reported, and clinical data available to consolidate information and begins to identify comprehensive member needs
Follows members through their inpatient behavioral health 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 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
Applies and/or interprets applicable criteria and clinical guidelines, standardized care 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 program representatives as needed to overcome barriers to meeting goals and objectives
Presents cases at case conferences/rounds to obtain a 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
Communicates and collaborates with 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 members 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 procedure

Requirements:

3-5 years of direct clinical practice experience post master’s degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility
2+ years demonstrated proficiency with personal computer, keyboard navigation, and MS Office Suite applications (Teams, Outlook, Word, Excel, SharePoint, etc.)
Minimum of a Master's degree in Behavioral/Mental Health or related field
Unencumbered Behavioral Health clinical license in the state of Oklahoma
Oklahoma-licensed mental health professional- Licensed Professional Counselor (LPC), Licensed Marriage & Family Therapist (LMFT), Licensed Behavioral Practitioner (LFP), or Licensed Clinical Social Worker (LCSW) with current unencumbered license

Nice to have:

Crisis intervention skills
Managed care/utilization review experience
Case management and discharge planning experience
Experience providing care to American Indian/Indigenous American/Native American populations

What we offer:

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and 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:
August 05, 2025

Expiration:
August 15, 2025

Employment Type:

Fulltime

Work Type:

On-site work

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Transition of Care Coordinator