Remote Transition Coordinator RN, OK

CVS Health

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Job ID: 2543715BR
Category: Nurse
Address:
Location: Oklahoma City, OK
Remote: Hybrid

Job Description
Business Overview:
Aetna Better Health of Oklahoma, a CVS Health company, embodies the vision to be a trusted health partner in the local Oklahoma communities we serve. We provide a full array of innovative services that enhance overall wellness and improve everyday life for our members. At Aetna Better Health of Oklahoma, we value professional development and career growth. You will work along other colleagues who align on Heart at Work behaviors and bringing your heart to every moment of health. We will support you all the way!

Position Summary:
Qualified candidates must reside in Oklahoma. The Transition Coordinator oversees all member transitions and Contractor compliance with all policies in accordance with the requirements of Section 1.10: “Transition of Care (TOC)” of this Contract.

The Transition Coordinator 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. As a member of the Key Personnel team for Aetna Better Health of Oklahoma, the candidate will need to travel to required meetings throughout the state.

Fundamental Components:
• Oversee all transitions, monitor our compliance with contractual requirements and serve as Oklahoma’s single point of contact for all transition-related activities.
• Complete care coordination duties related to complex patient populations and collaborate with community programs and providers including both mental health and medical services.
• Coordinate transition of care for members discharging from inpatient settings, to/from the Aetna Medicaid program, between care entities (CEs), between SoonerSelect and specialty programs, and out of home placements.
• Facilitate member access to transition services, such as community services, provider outreach services, while in urgent recovery centers, crisis stabilization units, and inpatient hospitals, to support the successful transition to the community from higher levels of care.
• Work with support staff to resolve any issues related to previously authorized medically necessary services
• Develop strong relationships with providers, including facility staff, discharge planners, physical and behavioral health providers, and community resources.
• Participate in multidisciplinary and UM case rounds as needed.
• Act as liaison for community providers and care management, including State, County, and community providers, providing information on physical and mental health and substance abuse programs, resources, and care program referrals.
• Interact with clinical and senior leaders within the health plan to discuss member specific health and service needs.
• Monitor the administration of state specific programs to ensure compliance with required processes, identify staff training needs, and to collect program outcome data.
• Participate in the oversight and creation of policies and procedures related to transitions of care for behavioral and physical health services.
• Coordinate with health plan staff (e.g. Utilization Management, Care Management) to secure needed services for individual members, possibly including court ordered treatment for behavioral health issues, legal guardianship etc.
• In conjunction with health plan staff (e.g. Utilization Management, Care Management) coordinate processes related to behavioral and physical health services, involving primary care physicians and related care team participants.
• Collaborate with Provider Services in monitoring the network to ensure compliance with state/contractual requirements and to identify service gaps in the network.
• Identify areas of concern related to program administration and participate in the development and implementation of appropriate corrective action.
• May provide oversight of special projects.
• May participate in training new and existing health plan staff on new programs, member health and service needs, and provider-related processes.
• Facilitate effective interactions with network and community service providers through provider education on behavioral and physical health, social service needs, and utilization.
• Experience working with diverse populations and clinical knowledge.
• Strong general knowledge of the health benefits business, clinical issues, trends and medical management, as well as medical cost management and quality improvement.
• Analytical, critical thinking and decision-making skills.

Pay Range
The typical pay range for this role is:
Minimum: 58,760
Maximum: 125,840

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.

For more detailed information on available benefits, please visit

jobs.CVSHealth.com/benefits

Required Qualifications
• RN with current unrestricted OK state licensure required.
• 3+ years’ experience in the health care delivery system e.g., clinical practice and health care industry.
• 3+ years demonstrated proficiency with personal computer, keyboard navigation, and MS Office Suite applications (Teams, Outlook, Word, Excel, SharePoint, etc.)
•Must possess reliable transportation and be willing and able to travel in-state up to 25% of the time. Mileage is reimbursed per our company expense reimbursement policy.

COVID Requirements

COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications
• Crisis intervention skills preferred.
• Medicaid, insurance experience preferred.
• Managed Care experience preferred.
• BSN degree preferred.

Education
Minimum of Associates or diploma nursing degree.

Business Overview
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. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.