Transition Coordinator

Humana•Work at Home - Indiana, IN

17h•$59,300 - $80,900•Remote

About The Position

The Transition Coordinator (Care Coach 2) evaluates members’ needs and requirements to help achieve or maintain optimal wellness. The Coordinator guides members and families to appropriate care and community resources and facilitates interactions with providers, payer sources, interdisciplinary teams, and others involved in a member’s care. Work assignments are varied and frequently require interpretation and independent determination of appropriate courses of action. The role supports and oversees initial and ongoing transitions in and out of Indiana Medicaid programs, the Contractor’s enrollment, and different care settings. It helps plan and prepare for transitions, coordinates follow-up care, and works with member-focused departments to support continuity of care and communication among members and providers. The Coordinator ensures the transfer and receipt of outstanding prior authorization decisions, utilization management data, and clinical information. The position includes assessing member needs, establishing individualized care plans, coordinating services, and helping members transition to the least restrictive appropriate setting. It also involves telephonic and in-person meetings within an assigned region with long-term care members, discharge planners, family members or power of attorney representatives, primary care providers, and other healthcare professionals. The position is remote, with occasional travel to Humana offices for training or meetings. Home or hybrid employees must have a dedicated, private workspace and meet the stated internet requirements.

Requirements

Bachelor’s degree in a health and human services field.
At least 2 years of relevant experience.
Intermediate to advanced proficiency with Microsoft Word, Excel, and Outlook.
Detail-oriented and comfortable working with tight deadlines in a fast-paced environment.
Strong verbal and written communication skills.
Passion for contributing to an organization focused on continuously improving consumer experiences.
Must complete tuberculosis screening if selected for the patient-facing role.
Must have a valid state driver’s license and maintain personal vehicle liability insurance at the applicable state minimum or the stated coverage limits, whichever is higher.
Must have a separate room with a locked door for use as a home office to ensure continuous privacy.
For home or hybrid work, self-provided internet must have at least 25 Mbps download and 10 Mbps upload speed, and the workspace must be dedicated and free from ongoing interruptions to protect member PHI and HIPAA information.

Nice To Haves

Master’s degree.
Applicable state license in the field of study.
Case Management Certification (CCM).
InterQual or Milliman experience.
Prior experience with Medicare and Medicaid recipients.
Experience with electronic case note documentation and documenting in multiple computer applications or systems.
Experience with health promotion, coaching, and wellness.
Knowledge of community health and social service agencies and other community resources.

Responsibilities

Support and oversee initial and ongoing member transitions in and out of Indiana Medicaid programs, the Contractor’s enrollment, and among care settings.
Assist with planning and preparing for transitions and arranging follow-up care after transitions are completed.
Coordinate with the Member Advocate Coordinator and other member-focused departments to support continuity and coordination of care and communication during transitions, benefit plan changes, and MCE transfers.
Ensure the transfer and receipt of outstanding prior authorization decisions, utilization management data, and clinical information, including prevention and wellness program information and care management and complex case management notes.
Assist members transitioning from custodial settings to home and community-based settings.
Conduct telephonic and in-person meetings within the assigned region with long-term care members, hospital and rehabilitation discharge planners, family members or POAs, PCPs, and other healthcare professionals to help prevent custodial placements when possible.
Assess and evaluate members’ needs to establish member-specific care plans and coordinate services.
Assess care needs and support transitions to the least restrictive setting that can achieve or maintain optimal well-being.
Guide members and families to appropriate care resources and facilitate interactions with payer sources, providers, interdisciplinary teams, and others involved in members’ care.