Registered Nurse -Post Acute Care Initiatives Hybrid/Float Rn Onsite Nyc

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose 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. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
A Brief Overview
This is a unique hybrid position that will support the an external provider team as a Float Registered Nurse. This position will help to help cover for the team if and when needed and for all the three initiatives - Skilled Nursing Facility, Home Health Care and Inpatient Strategy. Position requires cross training to understand the goals and operational workflows for the three initiatives mentioned above.
Approximately 70% of the time is remote/home-based work, with 30% of the time being onsite.
Working schedule is Monday-Friday; will work between 8am - 5pm EST. No nights, no weekends, no on call and no holidays.
What you will do
Home Health Care Initiative:

• Uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria for the most appropriate treatment, care or services for patients.
• Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment.
• Through broad knowledge of clinical care the Home Health Utilization RN evaluates, predicts, and facilitates the trajectory of patient care.
• Care Coordination and facilitation for community-based home health referrals or linkage to alternative community resources to obtain appropriate care.
• Will identify and coordinate appropriate community-based services in lieu of home health, when appropriate.
• Engages with the patient/caregiver telephonically using tools such as standard assessments, patient care plans, and documents all interactions in the EHP.
• Home Health Utilization RN will communicate patient plan of care and discharge status with the Primary Care Physician and/or Specialist.
• Provides clinical expertise and helping to clarify referral source directives and community-based linkage.
• Participates in performance, operational and quality improvement activities and ensures the collection of data for improvement analysis and prepares reports as requested.
• Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas.
• Responsible for performing other duties as requested by Associate Director, Post-Acute Care and MSHP Leadership

Population Health Transitional Care Coordination - Inpatient Strategy:

• Responsible for reviewing and assessing MSHP aligned Acute Care patients
• Establishes, revises, and evaluates a plan of care which is appropriate to problems identified and involves the patient/family and interdisciplinary team
• Provides for continuity of care by participating in discharge planning with patients, families and inpatient/outpatient team as appropriate, providing home instructions to patients and caregivers, recommending and or providing equipment/home modifications, and recommending appropriate follow-up care if needed. In instance that sub-acute rehabilitation is necessary, educates patient and caregiver on preferred provider network
• Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members
• Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render determination/recommendation along the continuum of care
• Responsible for communicating with interdisciplinary teams
• Attend and participate in daily rounds with the interdisciplinary team, reporting any concerns and recommendations for the MSHP aligned patients
• Responsible for documentation
• Responsible for performing other duties as requested by Population Health Manager, Associate Director, Post-Acute Care and MSHP Leadership

Population Health Post-Acute Care Clinical Coordinator - Skilled Nursing Facility Initiative:
Responsible for reviewing and evaluating post-Acute Care services provided to MSHP population

• Identify on a daily basis, MSHP lives that are being serviced in SNFs
• Conduct patient reviews, assess the plan of care and reinforce the goal LOS
• Address and discuss potential discharge needs and barriers
• Assure SNF providers are implementing care pathways and best practice

Responsible for reinforcing quality and evidence-based care in an effort to reduce cost, optimize therapeutic outcomes and improve quality of life for MSHP patients

• Actively participates in clinical rounds, reviewing care plans with care providers
• Identifies progress toward desired outcomes and intervenes to overcome deviation in expected plan of care
• Generates quality improvement results
• Refers cases with quality care concerns to the Associate Director, Post-Acute Care and VP of Care Transitions

Responsible for identifying potentially unnecessary services and care delivery settings, and recommends alternatives if appropriate, by analyzing clinical protocols

• Functions as liaison between MSHP and the SNF
• Actively participates in discharge planning
• Focuses on inappropriate utilization of services while ensuring appropriate care is provided

Responsible for the process of monitoring and evaluating the services and resources provided in response to a patient's needs

• Oversees data collection process
• Reviews utilization patterns; identifies trends and problems

Responsible for performing other duties as requested by Associate Director, Post-Acute Care and MSHP Leadership
For more information on our benefit programs, please visit
https://jobs.cvshealth.com/employee-benefits
Required Qualifications
Current and unrestricted RN license for the state of NY.
5 years of nursing experience.
1 year experience in Utilization Management.
Reliable transportation required.
Mileage is reimbursed per our company expense reimbursement policy.
Depending on requirements of provider offices, certain vaccines (i.e., COVID, Flu) may be a requirement of the role, as well as additional health screenings (i.e., drug screen, vaccine titers).
Preferred Qualifications
Excellent negotiation, problem solving and decision-making skills.
Excellent relationship management skill and non-aggressive assertiveness
Ability to organize and high-level of attention to detail
Computer literacy in EMR (Electronic Medical record) and Microsoft Suite (Word, Excel and PowerPoint)
CCM Certification
Excellent analytic and problem-solving skills
Ability to work independently (this position will be field work and work from home)
Effective computer skills including navigating multiple systems and keyboarding.
Experience in Home Care and/or sub-acute rehabilitation preferred.
Education
Associate degree minimum as Registered Nurse
Pay Range
The typical pay range for this role is:
$60,522.80 - $129,600.00
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.
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.
For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits
We anticipate the application window for this opening will close on: 04/29/2024
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.