Transition Coordinator

DRISCOLL HEALTH PLAN•Corpus Christi, TX

About The Position

The STAR Kids Transition Coordinator understands that the transition to adulthood is one of the most significant events in an individual’s life, especially for individuals with disabilities receiving publicly funded services under a children’s program. Federal and state public policies use different sets of eligibility criteria, new program service arrays, and limitations on nursing/attendant hours for adult programs which may offer less intensive services than children’s programs. Preparing for adult transition requires significant early planning led by a transition coordinator who assembles a transition team and develops a transition plan with an extensive array of activities to maximize independence and assist the youth in qualifying for the appropriate adult programs. The STAR Kids Transition Coordinator will oversee and lead all transition activities from initial contact through final transition to STAR+PLUS, other HHSC programs or other community-based programs. The STAR Kids Transition Coordinator is committed to ensuring that all members live in the most integrated residential setting of their choice. In addition, the STAR Kids Transition Coordinator will work with the nursing facility or intermediate care facility to relocate the member back to the community setting of their choice.

Requirements

Knowledge in Texas Medicaid criteria/guidelines preferred.
Knowledge about managed care contracts/guidelines preferred.
Knowledge of programs and services required to support the health and medical needs of disabled children preferred.
Knowledge of various reimbursement mechanisms, including third party requirements preferred.
Microsoft Office skills preferred.
Maintains utmost level of confidentiality at all times.
Maintains compliance with regulatory agencies that conduct intermittent reviews and audits to ensure contractual and regulatory compliance with Federal, State entities as well URAC.
Implements and adheres to Health System and Health Plan policies and procedures for members with special health care needs (STAR Kids).
Demonstrates business practices and personal actions that are ethical and adhere to Corporate Compliance and integrity guidelines.
Must be knowledgeable about children’s issues, transition activities, local community resources, Medicaid eligibility, guardianship issues, and working with individuals with complex needs and their families, STAR+PLUS, programs administered by the Department of Aging and Disability Services (DADS), TEA, Department of Assistive and Rehabilitation Services (DARS) and all other relevant state agencies and community-based organizations.
Must be knowledgeable about managed care Medicare/Medicaid criteria/guidelines.
Must have a working knowledge of various reimbursement mechanisms including third party requirements and Medicare.
Bachelor's degree from four-year college or university; or equivalent combination of education and experience preferred.
Minimum 3 years’ transition or community resource experience (pediatric preferred) or 1 year experience in managed care or case management.
Previous experience with the State of Texas STAR+PLUS program or similar programs dealing with SSI and disabled children preferred.
Knowledge of Medicaid/Medicare preferred.
Current driver’s license and insurance.

Nice To Haves

Knowledge in Texas Medicaid criteria/guidelines
Knowledge about managed care contracts/guidelines
Knowledge of programs and services required to support the health and medical needs of disabled children
Knowledge of various reimbursement mechanisms, including third party requirements
Microsoft Office skills
Transition or community resource experience (pediatric preferred)
Previous experience with the State of Texas STAR+PLUS program or similar programs dealing with SSI and disabled children
Knowledge of Medicaid/Medicare

Responsibilities

Function in an advisory role to the Medical Directors and Medical Management Committee in the following areas: Provide evaluation of and assist in the development of quality patient care services offered by DCHP; Assist in the establishment of patient care and professional staff policies and procedures of DCHP; and Participate in long-range planning of services and/or programs offered by DCHP.
Assemble a transition team and develop a transition plan with an extensive array of activities to maximize independence and assist the youth in qualifying for the appropriate adult programs for those members who will be aging out of STAR Kids.
Develop policies, informational material, resource guides, transition assessment, transition readiness, planning/integration into adult services, and transference and admissions support to adult services.
Oversee and lead all transition activities from initial contact through final transition to STAR+PLUS or other community-based programs.
Be knowledgeable about children’s issues, transition activities, local community resources, Medicaid eligibility, guardianship issues, and working with individuals with complex needs and their families, STAR+PLUS, programs administered by the Department of Aging and Disability Services (DADS), TEA, Department of Assistive and Rehabilitation Services (DARS) and all other relevant state agencies and community-based organizations.
Conduct a transition assessment that results in a continuity of care plan and checklist that captures all the youth’s needs and all necessary and relevant activities are met with no breaks in service or medication availability.
Identify adult healthcare providers and assist in transitioning member to new provider.
Work with a nursing facility (NF) or intermediate care facility (ICF) to establish a permanency plan to relocate the Member back to the community setting of their choice.
Establish communication links with appropriate staff/permanency planners, an effective monitoring schedule, establishing written service plan for safe relocation, and identifying appropriate short-term intensive services/supports for post-relocation community placement to help ensure stabilization.
Conduct other appropriate assessments according to STAR Kids contract.
Negotiates with vendors when necessary for services/equipment.
Ensure appropriate referrals to agencies and assistance programs are completed.
Complete documentation about a member’s plan of care, progress toward meeting care goals, outcomes, case reports, etc.
Produce status reports on a regular basis to track members in STAR Kids.
Participates in health plan’s performance improvement activities.
Participates in health plan committees as appropriate and on request.
Communicates with management regarding status of current workload and turn-around time discrepancies as necessary. Must obtain approval from manager or designee to any redistribution of workload.
Ensure thorough knowledge of the STAR Kids contract and meet all Service Coordination contract requirements.
Perform other such professional services as may be requested by DCHP from time to time.