Transition Specialist

Centene Corporation•Remote-WI, WI

7d•$27 - $49•Remote

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. Join Centene as a Remote Transition Specialist supporting our ED Transitions of Care (TOC) team in Wisconsin. The ideal candidate will have a background in healthcare and/or behavioral health, along with familiarity with Wisconsin Medicaid. In this role, you will manage a high volume of inbound and outbound calls, complete assessments, and develop individualized care plans to help members successfully navigate transitions in care.

Requirements

Requires a Bachelor's degree and 2 – 4 years of related experience. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
Background in healthcare and/or behavioral health
Familiarity with Wisconsin Medicaid

Responsibilities

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