Introduction to CVS Health and Our Purpose
At CVS Health, we are driven by a singular purpose: to bring our heart to every moment of our customers' health. This purpose is the foundation of our commitment to delivering enhanced, human-centric healthcare in a rapidly changing world. Our brand, with heart at its center, 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, empowering every colleague to play a role in transforming our culture and accelerating our ability to innovate and deliver solutions that make healthcare more personal, convenient, and affordable.
Job Overview
We are seeking a skilled and motivated Transition of Care Coordinator, Behavioral Health to join our team in Oklahoma. This full-time, field-based teleworker opportunity is ideal for a professional who is passionate about driving care management and care coordination activities across the continuum of care. As a Transition of Care Coordinator, you will utilize advanced clinical judgment and critical thinking skills to facilitate appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wrap-around services.
Key Responsibilities
- Telephonically and/or face-to-face assess, plan, implement, and coordinate all care management activities with members to evaluate their medical and behavioral health needs and facilitate overall wellness.
- Develop a proactive course of action to address issues presented, enhancing short and long-term outcomes and opportunities to enhance a member's overall wellness through integration.
- Conduct comprehensive assessments of referred members' needs/eligibility, determining the approach to case resolution and/or meeting needs by evaluating the member's benefit plan and available internal and external programs/services.
- Apply clinical judgment to incorporate strategies designed to reduce risk factors and address complex clinical indicators that impact care planning and resolution of member issues.
- Complete assessments, taking into account information from various sources, to address all conditions, including co-morbid and multiple diagnoses that impact functionality and include the member's restrictions/limitations.
- Perform crisis intervention with members experiencing a behavioral health or medical crisis, referring them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated.
- Provide crisis follow-up to members to ensure they are receiving the appropriate treatment/services.
- Apply and interpret applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member needs to ensure appropriate administration of benefits.
- Consult with managers, Medical Directors, and/or other physical/behavioral health support staff and providers to overcome barriers to meeting goals and objectives.
- Presents cases at case conferences to obtain a multidisciplinary view to achieve optimal outcomes.
- Work collaboratively with the member's interdisciplinary care team.
- Identify and escalate quality of care issues through established channels.
- Utilize influencing/motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
- Provide coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
- Help members actively and knowledgably participate with their provider in healthcare decision-making.
- Analyze utilization, self-report, and clinical data available to consolidate information and begin to identify comprehensive member needs.
- In collaboration with the member and their care team, develop and monitor established plans of care to meet the member's goals.
- Utilize case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
- Facilitate clinical handoffs during transitions of care.
Essential Qualifications
- Must reside in Oklahoma.
- Oklahoma-licensed mental health professional: Licensed Professional Counselor (LPC), Licensed Marriage & Family Therapist (LMFT), Licenses Behavioral Practitioner (LBP), or Licensed Clinical Social Worker (LCSW) with a current unencumbered license.
- 3+ years of clinical practice experience (e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility).
- Crisis intervention skills.
- Must successfully complete the Behavioral Health Case Manager certification training provided through the Department of Mental Health and Substance Abuse Services within 6 months of the hire date.
- 2+ years of experience using a personal computer, keyboard navigation, navigating multiple systems and applications, and using MS Office Suite applications (Teams, Outlook, Word, Excel, etc.).
- Must possess reliable transportation and be willing and able to travel in-state up to 30% of the time. Mileage is reimbursed per our company expense reimbursement policy.
- Willing and able to provide on-call CM coverage for nights and weekends on a rotational schedule as required by the State regulatory agency.
Preferred Qualifications
- Experience providing care to American Indian/Indigenous American/Native American populations.
- Case management in an integrated model.
- Managed care/utilization review experience.
- Case management and discharge planning experience.
Education
Minimum of a Master's degree in a behavioral health field (e.g., counseling, marriage & family therapy, or social work).
Career Growth Opportunities and Learning Benefits
At CVS Health, we are committed to the growth and development of our colleagues. As a Transition of Care Coordinator, you will have access to a range of training and development opportunities, including the Behavioral Health Case Manager certification training. You will also be part of a multidisciplinary team, working collaboratively with other healthcare professionals to deliver high-quality care and services to our members.
Work Environment and Company Culture
Our company culture is built on a foundation of respect, empathy, and inclusivity. We value diversity and promote a culture of belonging, where every colleague feels empowered to contribute and make a difference. As a remote worker, you will be part of a virtual team, with opportunities to connect with colleagues and leaders through regular meetings and events.
Compensation, Perks, and Benefits
The typical pay range for this role is $52,520.00 - $113,360.00 per year, depending on experience and qualifications. In addition to your compensation, you will be eligible for a range of benefits, including medical, dental, and vision insurance, a 401(k) retirement savings plan, and an Employee Stock Purchase Plan. You will also have access to numerous well-being programs, education assistance, and free development courses.
Conclusion
If you are a passionate and skilled healthcare professional, looking for a challenging and rewarding role, we encourage you to apply for this Transition of Care Coordinator, Behavioral Health opportunity. As a member of our team, you will have the opportunity to make a real difference in the lives of our members, while also developing your skills and advancing your career. Don't miss out on this exciting opportunity to join our team and contribute to our mission of delivering high-quality, patient-centered care.
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