Transition of Care Associate

CVS Health

. Complete post-discharge questionnaires and outreach cadence calls within required compliance-driven timelines .

Posted 11/2/2026full-timeRemote • Pennsylvania • United StatesJuniorMid-Level💰 $22 - $49 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in discharge planning, care coordination, and member education, ensuring compliance with healthcare regulations while effectively managing transitions of care. Proficient in utilizing holistic assessments and reporting to enhance member health outcomes and reduce hospital readmissions.

Highest-signal resume keywords

Discharge PlanningLPN/LVN LicenseCare CoordinationEffective CommunicationMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Discharge PlanningCare CoordinationMedication ManagementHolistic AssessmentsUtilization ReportingPrior Authorization CoordinationCondition ManagementCommunity Resource IdentificationCase PresentationBehavioral Health Assessment

Soft Skills

MultitaskingPrioritizationAdaptabilityVerbal CommunicationWritten Communication

Tools & Technologies

Microsoft WordMicrosoft ExcelMicrosoft Outlook

Certifications & Qualifications

LPN/LVN LicenseCompact Licensure

Industry Keywords

ComplianceCare Team CoordinationInterdisciplinary MeetingsBenefit EducationEmergency Department Utilization30-Day Hospital ReadmissionsClinical Functionality Resources

About the role

Key responsibilities & impact

Complete post-discharge questionnaires and outreach cadence calls within required compliance-driven timelines
Provide comprehensive discharge planning and coordinate seamless transitions to the next care setting
Ensure members fill or receive medications and understand how to take them
Provide benefit education and clinical assistance for services and supports
Coordinate prior authorizations, PCP and specialty provider communication, condition management, medication management, and community resources
Evaluate health and social indicators and identify barriers to optimal member health
Apply strategies to reduce member risk
Present cases at multidisciplinary case conferences
Coordinate care with the care team to support optimal wellness and self-management
Coordinate post-discharge meal delivery, secure DME, and support timely physician follow-up
Explain payer and plan benefits, policies, and procedures to providers, members, and key personnel
Update care plans following changes in condition or behavioral health status
Use reporting to identify utilization and reduce Emergency Department utilization and 30-day hospital readmissions
Follow members from inpatient admission through the care continuum until return to prior community functioning
Facilitate interdisciplinary care team meetings with Social Services, Care Management, PCPs, and other key participants
Review prior claims to assess impact on case management and eligibility status
Use holistic assessments and questionnaires to identify referrals to clinical functionality resources

Requirements

What you’ll need

2+ years work experience
LPN/LVN License in good standing with no restrictions required
Discharge planning
Advanced proficiency in Microsoft Word, Excel, and Outlook
Ability to multitask, prioritize, and effectively adapt to a fast-paced changing environment while providing outstanding care
Effective verbal and written communication skills
Associate's Degree Required
Bilingual preferred
Compact Licensure preferred
Bachelor's Degree Preferred

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program in addition to base pay
Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being, based on eligibility