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At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

**Summary** :

The Transition of Care Coordinator Behavioral Health utilizes advanced clinical judgment and critical thinking skills to facilitate appropriate member behavioral health transitions. The TOC Coordinator BH leverages case management tools, such as assessments and care planning, direct provider coordination/collaboration, and coordination of wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.

Position Responsibilities:

+ Ensures safe and appropriate transitions between settings by collaborating with identified points of contact at facilities, members, responsible parties, legal guardians, providers, and support networks through the interdisciplinary care team process.

+ Through the use of clinical tools and information/data review, conducts assessments of referred member’s needs/eligibility and determines approach to meeting needs by evaluating available internal and external programs and services.

+ Analyzes utilization, self-reported, and clinical data available to consolidate information and begins to identify comprehensive member needs.

+ Follows members through their inpatient behavioral health admission and continues oversight through transition from the acute setting to all other settings with the goal of reducing readmissions and increasing permanency in the community.

+ Available to conduct face-to-face visits as necessary for high risk members.

+ Coordinates care and reassess member’s need 2-day, 7-day, and 14-day post-discharge timeline recommended by the Coleman Care Transitions Model.

+ Ensures members transition upon discharge with adequate supervision, recommended behavioral health, physical health, pharmacy resources, and care management support.

+ Educates and supports member/caregiver focusing on seven primary areas: medication management, use of personal health record, follow-up care, signs and symptoms of worsening condition, nutrition, functional needs and advance directives.

+ Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues.

+ Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated.

+ Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services.

+ Applies and/or interprets applicable criteria and clinical guidelines, standardized care management plans, policies, procedures, and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits.

+ Using a holistic approach consults with managers, medical directors and/or other program representatives as needed to overcome barriers to meeting goals and objectives.

+ Presents cases at case conferences/rounds to obtain a multidisciplinary view in order to achieve optimal outcomes.

+ Engages and builds continued professional relationships at network facilities.

+ Identifies and escalates quality of care issues through established channels.

+ Communicates and collaborates with medical and behavioral health professionals to influence appropriate member care.

+ Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health.

+ Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.

+ Helps members actively and knowledgably participate with their provider in healthcare decision-making.

+ In collaboration with the member and their care team develops and monitors established plans of care to meet the member’s goals.

+ Utilizes case management, utilization management, and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedure.

**Must reside in the following counties:** Alfalfa, Beaver, Beckham, Blaine, Canadian, Cimarron, Craig, Custer, Delaware, Dewey, Ellis, Garfield, Grant, Harper, Kay, Kingfisher, Logan, Major, Mayes, Noble, Nowata, Osage, Ottawa, Pawnee, Payne, Rogers, Roger Mills, Texas, Tulsa, Washita, Washington, Woods, Woodward.

**Reports to:** Manager, Clinical Health Services

**Required Qualifications** :

+ 3-5 years of direct clinical practice experience post master’s degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility

+ 2+ years demonstrated proficiency with personal computer, keyboard navigation, and MS Office Suite applications (Teams, Outlook, Word, Excel, SharePoint, etc.)

Preferred Qualifications:

+ Crisis intervention skills preferred

+ Managed care/utilization review experience preferred

+ Case management and discharge planning experience preferred

+ Experience providing care to American Indian/Indigenous American/Native American populations preferred

Educational - License/Credential Requirements:

+ Minimum of a Master's degree in Behavioral/Mental Health or related field

+ Unencumbered Behavioral Health clinical license in the state of Oklahoma

+ Oklahoma-licensed mental health professional- Licensed Professional Counselor (LPC), Licensed Marriage & Family Therapist (LMFT), Licensed Behavioral Practitioner (LFP), or Licensed Clinical Social Worker (LCSW) with current unencumbered license

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,095.00 - $116,760.00

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.

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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

+ **Affordable medical plan options,** a **401(k) plan** (including matching company contributions), and an **employee stock purchase plan** .

+ **No-cost programs for all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

+ **Benefit solutions that address the different needs and preferences of our colleagues** including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 06/13/2025

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

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 [email protected] 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.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.