Transition Specialist

Centene Corporation

1d•Hybrid

About The Position

Provides support with identifying, overseeing, and managing the coordination of transition of members in the community. Works with leadership to ensure the timely and safe transition of members in the community from various levels of health care services including coordinating care plans with community care coordinators, educating transition enrollees about services, requirements, limitations, and/or exclusions of services as a result of the transition. May perform and/or assist with member assessment/screenings; may develop and/or assist with developing member transition plan or service plan/care plan. Supports care coordination team, providers, and/or other health care team members to develop an effective transition plan for members in the community and/or into adulthood and adult services/providers, as appropriate Assists with the transition for members in the community based on enrollment or transition of care for services identified Works with care coordination and care management team to identify new member enrollees requiring transition services Ensures existing authorizations are honored during the transition process and works with care management team and providers to address any issues Acts as an available resource for members and their families and/or caregivers to educate on services, requirements, limitations, and/or exclusions of services as a result of transition planning May track and maintains transition metrics including new member assessments, volume of members transitioning into or out of care to identify trends and process improvements, and ensures all transition of care information is appropriately documented Supports with efforts to draft education materials and resources for members on requirements, limitations, or exclusions of services for transition of care Assists with developing education and training programs for care coordination staff and providers to improve transition services for members May evaluate the needs of the member, the resources available, and recommends and facilitates the plan for the best outcome May coordinate as appropriate between the member and/or family/caregivers and the care provider team to ensure members are being effectively treated Interacts with healthcare providers as appropriate to facilitate member care coordination needs Performs other duties as assigned Complies with all policies and standards

Requirements

Bachelor's degree and 2 – 4 years of related experience, or equivalent experience.
For Health Net of California: LVN/LPN State Licensure required.
Must be licensed in CA.
Prefer candidate to live in CA.
Will work PST hours.

Responsibilities

Identify, oversee, and manage the coordination of transition of members in the community.
Ensure the timely and safe transition of members from various levels of health care services.
Coordinate care plans with community care coordinators.
Educate transition enrollees about services, requirements, limitations, and/or exclusions of services.
Perform and/or assist with member assessment/screenings.
Develop and/or assist with developing member transition plans or service plans/care plans.
Support care coordination teams, providers, and other health care team members in developing effective transition plans.
Assist with transitions for members based on enrollment or transition of care for identified services.
Identify new member enrollees requiring transition services.
Ensure existing authorizations are honored during the transition process and work with care management teams and providers to address issues.
Act as a resource for members, families, and caregivers to educate on services, requirements, limitations, and/or exclusions.
Track and maintain transition metrics, including new member assessments and volume of members transitioning.
Support efforts to draft education materials and resources for members on transition of care requirements, limitations, or exclusions.
Assist with developing education and training programs for care coordination staff and providers.
Evaluate member needs and available resources to recommend and facilitate the best outcome plan.
Coordinate between members, families/caregivers, and care provider teams to ensure effective treatment.
Interact with healthcare providers to facilitate member care coordination needs.
Perform other duties as assigned.
Comply with all policies and standards.