RN Senior Transition Specialist

Centene Corporation•Remote-NH, MA

19d•$31 - $55•Hybrid

About The Position

Provides expertise in identifying, overseeing, and managing the coordination of member transitions in the community. Works with leadership to address complex issues and ensures timely, safe transitions between levels of health care services. This includes coordinating care plans with community care coordinators and educating transition enrollees about services, requirements, limitations, and exclusions. May perform or assist with member assessments and screenings, and may develop or assist with developing member transition, service, or care plans. This is a hybrid position involving in-person and telephonic outreach. Field visits occur weekly, biweekly, or monthly based on business needs. The position works with care coordination teams, providers, members, and caregivers to facilitate effective transitions and care coordination, and partners with leadership to improve transition processes.

Requirements

Bachelor's degree and 4–6 years of related experience, or equivalent experience acquired through applicable knowledge, duties, scope, and skills reflective of the position level.

Nice To Haves

For New Hampshire Health Families, an RN license is highly preferred.

Responsibilities

Work with care coordination teams, providers, and other health care team members to develop effective transition plans for members in the community.
Assist with member transitions based on enrollment or identified transitions of care for services.
Work with care coordination and care management teams to identify new member enrollees who require transition services.
Ensure existing authorizations are honored during transitions and collaborate with care management teams and providers to address issues.
Educate members and their families or caregivers about services, requirements, limitations, and exclusions related to transition planning.
Review transition metrics, such as new member assessments and member transitions into or out of care, to identify trends and process improvements; ensure transition-of-care information is appropriately documented.
Partner with leadership to identify transition-of-care process improvements and provide recommendations.
Assist in developing member education materials and resources about service requirements, limitations, or exclusions related to transitions of care.
Assist in developing education and training programs for care coordination staff and providers to improve transition-of-care services.
Evaluate member needs and available resources, and recommend and facilitate plans for the best outcome.
Coordinate, as appropriate, between members or their families and caregivers and care provider teams to support effective treatment.
Interact with health care providers as appropriate to facilitate member care coordination needs.
Perform other duties as assigned.
Comply with all policies and standards.