Medicare Transition Coordinator - Long Term Services & Support (LTSS) - Southfield, Michigan

Amerihealth Caritas Health Plan • Southfield, MI

364d • Hybrid

About The Position

AmeriHealth Caritas is seeking a Medicare LTSS Transition Coordinator responsible for managing a patient's successful transition from hospital to home or alternate location. This role involves developing, implementing, and evaluating comprehensive transitional care interventions for members. The coordinator will work with complex patients and is accountable for managing post-acute care to prevent poor health outcomes, frequent emergency room visits, and hospital readmissions. The position requires collaboration with various healthcare professionals and the ability to assess and address the needs of patients effectively.

Requirements

• 1 to 3 years experience with transition of care and/or care coordination activities.
• Bachelor's Degree required.
• Active and unrestricted Registered Nurse licensure (R.N.) required.
• Proficient PC skills with Microsoft Office Suite and Electronic Health Records.
• Strong knowledge of Medicare/MMP/DSNP Integrated Care Management programs.
• Ability to communicate with beneficiaries who have medical needs and communication barriers.
• Ability to work independently or as a team.
• Ability to maintain positive relationships with both internal and external customers.

Nice To Haves

• Field experience (home health, etc.) preferred.

Responsibilities

• Perform telephonic or face-to-face clinical assessments for the identification, evaluation, coordination, and management of member's needs.
• Identify patient/family education needs through assessment.
• Critically evaluate and analyze physical and psychosocial assessment data.
• Perform medication reconciliation and partner with providers to address discrepancies.
• Assess complexity of care needs and potential/actual issues or gaps in care.
• Conduct health literacy assessments using defined industry tools.
• Interpret screening and selective laboratory/diagnostic tests.
• Initiate and maintain communication and collaboration with healthcare professionals and patients/families.
• Utilize resources to maximize healthcare benefits for members.
• Arrange post-discharge medical and community referrals for patients.
• Identify, track, and conduct root cause analyses on 30-Day readmissions.
• Participate in clinical performance improvement activities.
• Develop routine report materials and deliver presentations/reports.
• Travel throughout service areas as required.
• Interface with Medical Directors and other Integrated Care Team participants.
• Assist in problem-solving with providers, claims, or service issues.
• Direct the work of other licensed and unlicensed professionals as needed.
• Maintain current knowledge of CMS and DHHS requirements.
• Adhere to AmeriHealth Caritas policies and procedures.
• Create and support an environment that fosters teamwork, cooperation, respect, and diversity.
• Demonstrate commitment to corporate goals and objectives.
• Perform other related duties and projects as assigned.

Benefits

• Flexible work solutions including remote options and hybrid work schedules.
• Competitive pay.
• Paid time off including holidays and volunteer events.
• Health insurance coverage for you and your dependents on Day 1.
• 401(k).
• Tuition reimbursement.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees