Transition Coordinator

Humana • Work at Home - Indiana, IN

3d • $59,300 - $80,900 • Remote

About The Position

The Transition Coordinator (Care Coach 2) evaluates member's needs. This evaluation aims to achieve or maintain an wellness state. The Coordinator guides members/families toward resources and facilitates interaction with them. These resources are 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.

We are looking for telephonic and in-person meetings within an assigned region. The purpose of these meetings is to work with multiple partners. These partners include long-term care members, hospital/rehab staff discharge planners, family members/POA's, PCP's, and other health care professionals. The goal of these interactions is to prevent custodial placements whenever possible.

Assess and evaluate member's requirements to establish a member specific care plan and coordinates services
Ensure members are transitioning to the least restrictive setting to achieve or maintain well being by assessing their care needs
Guide members/families towards resources appropriate for their care. Facilitate interactions with other payer sources, providers, interdisciplinary teams and others involved in the member's care and required by our comprehensive contract to lead services.

Requirements

• Bachelor's degree in health and human services field
• 2 or more years of relevant experience
• Must be passionate about contributing to an organization focused on improving consumer experiences
• Must have a separate room with a locked door that can be used as a home office to ensure privacy while you work
• Must reside in Clark, Floyd, Harrison or Scott County (Indiana)
• Self-provided internet service must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

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 systems
• Experience with health promotion, coaching and wellness
• Knowledge of community health and social service agencies and additional community resources

Responsibilities

• Support the ongoing member transitions in and out of the Indiana Medicaid programs, the Contractor's enrollment, and among care settings.
• Helps prepare for transitions and follows up on care after completing transitions.
• The Member Advocate Coordinator and other member-focused departments of the plan work together to ensure continuity and coordination of care. This collaboration also facilitates member and provider communication through the initial transition, ongoing benefit plan, and MCE transfers.
• Ensure 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.
• Help with transitions from the custodial setting to the home and community-based setting.

Benefits

• medical, dental and vision benefits
• 401(k) retirement savings plan
• time off (including paid time off, company and personal holidays, 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