Transition of Care Associate - Licensed Practical Nurse

Position Summary 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 Dual Eligible Special Needs Plan (D‑SNP) 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, providers, 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 D‑SNP to change lives in new markets across the country. Responsibilities The Transition of Care Coach is responsible for care coordination of members experiencing a significant change in health status which has resulted in the necessity of an emergency department visit, inpatient, skilled nursing, or rehabilitative stay. Ensure members experience a seamless transition to their next care setting and facilitate post‑discharge goal attainment by completing post‑discharge questionnaires, providing comprehensive discharge planning, ensuring medication management, and conducting benefit education. Provide clinical assistance to determine appropriate services and supports due to member health needs (including prior authorizations, coordination with PCP and specialty providers, condition management education, medication management, community resources and supports). Evaluate health and social indicators, identify and engage barriers to achieving optimal member health, and use discretion to apply strategies to reduce member risk. Present cases at case conferences for multidisciplinary focus and facilitate overall care coordination with the care team to achieve optimal wellness within the confines of the member’s condition(s) and abilities to self‑manage. Coordinate post‑discharge meal delivery, assist with securing DME, and help ensure timely physician follow‑up. Understand payer/plan benefits, policies, procedures, and articulate them effectively to providers, members, and other key personnel. Update the care plan for any changes in condition or behavioral health status. Review prior claims to address potential impact on current case management and eligibility status. What You Will Do Complete outreach cadence calls and post‑discharge questionnaires within required compliance‑driven timelines. Utilize weekly and daily reporting to identify utilization for the purpose of reducing emergency department utilization and 30‑day hospital readmissions. Follow members identified as inpatient in hospitals (planned or unplanned admission) and then throughout the subsequent care continuum until the member can return to prior level of functioning in the community. Facilitate interdisciplinary care team meetings with social services, care management, PCP and other key players to discuss service needs and support safe transitions. Required Qualifications 2+ years of work experience as a Licensed Practical Nurse (LPN). Candidate must be a Licensed Practical Nurse (LPN) with active and unrestricted status. Discharge planning experience. Advanced proficiency in Microsoft Word, Excel, and Outlook. Ability to multitask, prioritize, and adapt to a fast‑paced changing environment while providing outstanding care. Effective verbal and written communication skills. Self‑motivated, energetic, detail‑oriented, highly organized, tech‑savvy. Preferred Qualifications Bilingual (written and spoken). Education: High School Diploma or Equivalent (required); Associate’s Degree (preferred). License: Active and unrestricted LPN (preferred). Weekly Hours 40 hours per week. Full‑time position. Pay Range The typical pay range for this role is $21.10 - $48.67 per hour. The actual base salary offer will depend on experience, education, geography and other relevant factors. Benefits Full‑time positions are eligible for a comprehensive benefits package that includes medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources based on eligibility. Application Deadline Application window closes on 06/25/2026. EEO Statement Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. #J-18808-Ljbffr