Embedded Transitional Care Manager - RN, CVS Health

CVS Health

Location:
United States, Philadelphia

Category:
Health and Beauty

Contract Type:
Employment contract

Salary:

60522.00 - 129615.00 USD / Year

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Job Description:

The role involves managing transitions of care for patients, advocating for them throughout the care continuum, identifying opportunities for quality care, engaging with different stakeholders, conducting assessments, medication reconciliation, and compliance with relevant criteria. It also involves supporting patients post-discharge and ensuring coordination across care teams.

Job Responsibility:

Manage patients through transitions of care, either face to face in the facility or telephonically, within a defined geographical area and care setting
advocate for the patient throughout the care continuum to ensure access to resources and resolution to all barriers to care
identify opportunities for improved program workflows, increased internal and external partnerships, and higher quality patient care
maintain real-time and accurate records of patient status through care transitions within Oak Street’s internal inpatient platform
adhere to CMS, state specific and NCQA compliance criteria as related to Transitions of Care
evaluate patient status post-ED visit or observation stay through a clinical assessment and medical record review
triage to determine appropriate follow up care and next steps, including reviewing medication lists and scheduling follow up appointments with the appropriate provider and/or specialists
engage directly with inpatient physicians, case managers, medical directors, and hospitalists (where applicable) to facilitate safe and timely discharge, appropriate follow-up care, and next steps
coordinate with the Utilization Management team to review medical and payer records to ensure appropriate length of stay and identify any barriers to discharge
conduct structured clinical assessment to identify post-discharge needs
conduct medication reconciliation on behalf of the PCP
participate in regular meetings with Oak Street Health regional leaders to coordinate program implementation and ongoing management
participate with the TCM Lead in quality assurance activities

Requirements:

An active RN license within the state of practice in good standing
willingness to obtain cross-state licensure, as needed
certified Case Manager (CCM) or equivalent case management certification required, or willingness to obtain within 12 months of hire
2+ years’ experience in transitional nursing, discharge planning, nursing case management, or home health
experience in utilization management preferred
knowledge of Medicare/Medicaid and NCQA regulatory transitions of care criteria
exceptional communication skills and customer service orientation
innovative and independent problem solving skills
ability to monitor and evaluate opportunities for cost-effective care options with high-quality outcomes
Spanish-speaking preferred but not required
a flexible, positive attitude
valid driver’s license and ability to travel daily
working knowledge of Microsoft Office Product Suite
US work authorization
someone who embodies being “Oaky”

Nice to have:

Experience in utilization management
Spanish-speaking

What we offer:

Mission-focused career impacting change and measurably improving health outcomes for Medicare patients
paid vacation, sick time, and investment/retirement 401K match options
health insurance, vision, and dental benefits
affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan
no-cost programs including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
benefit solutions such as flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access

Additional Information:

Job Posted:
August 02, 2025

Expiration:
December 31, 2025

Employment Type:

Fulltime

Work Type:

On-site work

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Embedded Transitional Care Manager - RN