Transition of Care - Registered Nurse

4004 Aetna Medicaid Administrators; Illinois; Hybrid; USD 67,000 - 143,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

PTO

Retirement plan

Wellness programs

Job summary

CVS Health is seeking a Transition of Care Case Manager (RN) to support high‑risk, medically complex members in Illinois. You will develop and implement individualized care plans, coordinate with interdisciplinary teams, and facilitate safe post‑discharge transitions while promoting health equity.

You’ll leverage clinical expertise and care coordination experience to reduce readmissions, educate members and families, and work from a home-based schedule designed for remote collaboration with

Qualifications

• Active and unrestricted RN license in Illinois.
• 3+ years of clinical practice experience.
• 1+ year of experience in care coordination or working with high-risk populations.
• Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, Teams).
• Ability to work from home in a private, dedicated space.

Responsibilities

• Complete post-discharge assessments to identify needs and health determinants.
• Provide comprehensive discharge planning and transitions of care between settings.
• Ensure medication reconciliation and understanding of prescribed medications.
• Coordinate with PCP, specialists, and ICT to develop ICPs and care plans.
• Lead ICT meetings and ensure timely communication with the care team.
• Support post-discharge services, transportation, and DME coordination.

Skills

RN License in Illinois

Care coordination

Microsoft Office Suite

Remote work

Private home workspace

Education

Active and unrestricted RN license

Bachelor's degree in Nursing

Tools

Microsoft Office

Job description

About CVS Health

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.

Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

Help us elevate our member care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life‑changing impact on our Fully Integrated Dual Eligible Plan (FIDE) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, provider and community organizations to address the full continuum of our members' health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country.

The Transition of Care CM plays a critical role in ensuring that our high‑risk, medically complex, and vulnerable members—those enrolled in HIDE/FIDE SNP and other Medicaid waiver programs—experience safe, effective, and seamless transitions across care settings. The TOC CM ensures the member experiences a seamless transition to their next care setting. This includes members undergoing significant changes in health status that result in emergency department visits, inpatient admissions, or stays in skilled nursing or rehabilitative facilities. This position provides comprehensive care coordination, assists with the development and implementation of care plans, facilitates communication with interdisciplinary teams, and supports members and families to reduce readmissions, promote health equity and improve health outcomes. Through person‑centered planning and timely interventions, the TOC CM ensures that all necessary care, supports, and services are in place at discharge to maintain continuity of care and support optimal recovery.

Key Responsibilities

• Complete a market‑specific post‑discharge assessment to identify member’s needs, including Health Related Social Needs and Social Determinants of Health (SDoH).
• Providing comprehensive discharge planning, including facilitating transitions of care between institutional and community settings, ensuring continuity and quality of care.
• Ensuring the member has filled/received their medication(s) and has an understanding on how to take their ordered medications.
• Providing clinical assistance to determine appropriate services and supports due to member’s health needs (including but not limited to: Prior Authorizations, Coordination with PCP and Specialty providers, Condition Management information and education, Medication management, Community Resources and supports).
• Identifying and engaging barriers to achieving optimal member health.
• Utilizing discretion to apply strategies to reduce member risk.
• Lead and coordinate the Interdisciplinary Care Team (ICT) to develop and implement Individualized Care Plans (ICPs).
• Facilitating overall care coordination with the care team to ensure member achieves optimal wellness within the confines of the member’s condition(s) and abilities to self‑manage.
• Coordinating post‑discharge meal delivery, assists with securing DME, and helps to ensure timely physician follow‑up.
• Provide education to members and caregivers on care plans, medications, and available community resources, as needed.
• Understanding Payer/Plan benefits, policies, procedures, and articulating them effectively to providers, members, and other key personnel.
• Updating the Care Plan for any change in condition or behavioral health status.

Additional Responsibilities

• Responsible for completing outreach cadence calls and post‑discharge questionnaires within required compliance driven timelines.
• Schedule follow‑up appointments and ensure medication reconciliation is completed.
• Identify and address barriers to care such as transportation, housing, or access to medications.
• Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department Utilization and 30‑day hospital readmissions.
• Follows members identified as inpatient in hospitals (whether planned or unplanned admission) and then throughout the subsequent care continuum until member can return to prior level of functioning in the community.
• Facilitates Interdisciplinary Care Team Meetings with Social Services, Care Management, PCP and other key players to discuss service needs and support safe transitions.
• Ensure compliance with state and federal regulations, including NCQA standards.

Required Qualifications

• Candidate must have an active and unrestricted Registered Nurse (RN) License in Illinois or be willing to obtain 3+ years of clinical practice experience.
• 1+ year(s) of experience in care coordination or working with high‑risk populations.
• Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools.
• Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually.
• Access to a private, dedicated space to conduct work effectively to meet the requirements of the position.

Preferred Qualifications

• Certified Case Manager.
• 3+ years Care Management, Discharge Planning and/or Home Health Care Coordination experience.
• Working knowledge of LTSS and HCBS options, Chronic disease management, Medication side effects, Health equity and cultural competency and Community‑based services and public benefits.
• Excellent analytical and problem‑solving skills.
• Effective communications, organizational, and interpersonal skills.
• Ability to work independently multitask, prioritize, and effectively adapt to a fast‑paced changing environment while providing outstanding care.
• Bilingual.

Education & Licensing

Associate’s Degree in Nursing (REQUIRED); Bachelor’s Degree in Nursing (PREFERRED).

License: Active and unrestricted Registered Nurse (RN) License in Illinois or willing to obtain.

Work Schedule

Anticipated Weekly Hours: 40

Time Type: Full time

Pay Range

The typical pay range for this role is: $66,575.00 - $142,576.00. 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.

Benefits

Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

Equal Opportunity Statement

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Company Culture

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

Our employees are self‑disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.