AZ – Work from home
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
The ED Hold Coordinator position is vital to the movement of our members who may be waiting in an emergency department and can either be safely transitioned back into the community with supports or require a clinically appropriate higher level of care. Coordinating with the outpatient providers, hospitals, and ancillary supports is crucial to developing sound discharge plans and identifying higher levels of care and supports. The ED Hold Coordinator typically monitors wait times that can be relatively brief, but for those members with more complex needs or barriers exist to transferring the member to an inpatient setting or discharging to the community, the ED Hold Coordinator may spend more time monitoring those cases and sharing information with relevant internal staff, assigned providers, and regulators when applicable to minimize the length of stay and reduce barriers to supporting the member in a more clinically appropriate setting, ideally in the least restrictive setting.
- Facilitate and participate in calls with crisis providers, hospitals, and other providers to help facilitate movement of members.
- Coordinate with outpatient providers, ancillary supports, and other community stakeholders to support movement of members from the emergency department.
- Collect, submit, and analyze data relevant to emergency department holds, hold times, and identify any trends and patterns.
- Participate in complex case review for members utilizing a high frequency of emergency department and/or crisis services.
- Utilizes critical thinking and knowledge of program requirements, network and community resources, and Medicaid benefits to facilitate appropriate physical and behavioral healthcare and social services for members through collaboration with clinical and program staff, direct provider collaboration, and coordination of psychosocial wraparound services to promote effective utilization of available resources, optimal member functioning, and cost-effective healthcare outcomes.
- Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation along the continuum of care facilitates including effective discharge planning.
- Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs.
- Daily review of the Health Information Exchange (HIE) reports for members who have presented to an ED to identify those who are holding for behavioral health reasons for regulator, provider, and internal notification and further care coordination.
- Ability to work well independently, as well as within a team structure.
- Access electronic health records from contracted providers to identify members who have presented for behavioral health needs, including but not limited to: reviewing hospital rapid response assessments, collateral documentation, and attending staff recommendations for ongoing care.
- Submit a daily spreadsheet for review and care coordination that includes member demographics, presenting concerns, location, recommendations, and if applicable, discharge information.
- Submit monthly reports to regulators identifying members holding greater than 24 hours and clinical efforts to coordinate care, barriers related to movement for the member out of the ED, and pertinent clinical information.
- Participate in regular meetings between regulators, stakeholders, and providers related to members and ED Hold trends
- LPC, LCSW, or similar with current Arizona independent state licensure, or an unrestricted Arizona RN licensure
- 2+ years of experience in behavioral health or social services
- 3+ years of experience with Microsoft Office applications, including Excel, Outlook, and Word; strong proficiency with Excel
- 5 years of direct clinical practice experience post master’s degree/RN licensure in behavioral health settings
- Proficiency with computer skills that include navigating multiple systems and keyboarding
- Effective communication skills, both verbal and written. Ability to present information to internal and external stakeholders. Ability to multitask, prioritize, and adapt.
- Strong time management skills
- Ability to work well independently and within a team structure.
- Experience working with adult and child/adolescent populations
- Case management experience
- Discharge planning experience
- Managed care experience
- Experience working in behavioral health crisis, inpatient, or an emergency department setting
- Experience collecting and analyzing data
- Bachelor’s Degree or non-licensed master’s level clinician required
The typical pay range for this role is:
$60,522.80 – $129,600.00
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.
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