Transition Coordinator

Humana • Work at Home - Indiana, IN

2d • Remote

About The Position

The Transition Coordinator (Care Coach 2) evaluates member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Coach 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Requirements

• Bachelor's degree in health and human services field
• 2 or more 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
• Must be passionate about contributing to an organization focused on continuously improving consumer experiences
• This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
• This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance.
• Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher
• Must have a separate room with a locked door that can be used as a home office to ensure continuous privacy while you work
• Must reside in one of the following Indiana Counties: Crawford, Orange, Lawerence, or Washington

Nice To Haves

• Master's Degree
• Applicable state license in field of study
• Case Management Certification (CCM)
• Interqual or Millman experience
• Prior experience with Medicare & Medicaid recipients
• Previous experience with electronic case note documentation and experienced with documenting in multiple computer applications/systems
• Experience with health promotion, coaching and wellness
• Knowledge of community health and social service agencies and additional community resources

Responsibilities

• Supports and oversees the initial and ongoing member transitions in and out of the various Indiana Medicaid programs, the Contractor's enrollment, and among care settings.
• Assists with the planning and preparation for transitions and the follow-up care after transitions are completed.
• Works with the Member Advocate Coordinator and other member-focused departments of the plan to ensure continuity and coordination of care and member and provider communication through the initial transition, ongoing benefit plan, and MCE transfers.
• Ensures the transfer and receipt of all outstanding prior authorization decisions, utilization management data, and clinical information such as prevention and wellness programs(s), care management and complex case management notes.
• Assist with transitions from the custodial setting to the home and community based setting.
• Requires telephonic and in-person meetings within assigned region to meet with the long term care members, hospital/rehab staff discharge planners, family members/POA's PCP's, and other health care professionals in order to prevent custodial placements when possible
• Assesses and evaluates member's needs and requirements in order to establish a member specific care plan and coordinates services
• Ensures members are transitioning to the least restrictive setting in order to achieve and/or maintain optimal well being by assessing their care needs
• Guides members/families towards resources appropriate for their care. Services are driven by facilitating interactions with other payer sources, providers, interdisciplinary teams and others involved in the member's care as appropriate and required by our comprehensive contract.

Benefits

• medical
• dental and vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave)
• short-term and long-term disability
• life insurance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level