Transitions Coordinator - Post Acute-4

CareSource • Ohio WFH, OH

8d • $62,700 - $100,400

About The Position

The Transitions Coordinator - Post Acute monitors and manages member level-of-care transitions to and from long-term care and respite nursing facility services, as well as enrollment or disenrollment in home and community-based services (HCBS) waiver services. The role uses clinical review and benefits management and partners with care coordination and waiver service coordination staff and other stakeholders to help ensure members receive appropriate supports and services throughout the transition process.

The Coordinator serves as a collaborative member of the interdisciplinary care team, supports timely and compliant transition reviews, verifies member eligibility and enrollment information, and helps members maintain benefit eligibility. The position coordinates clinical documentation and care planning, facilitates discharge planning, supports appeals and quality processes, and maintains knowledge of applicable regulations, contracts, and Medicare and Medicaid benefits. The Coordinator may participate in team meetings and hearings, mentor new staff, contribute to projects and data analysis, and perform other related duties as requested.

Requirements

• Completion of an accredited Registered Nurse degree program or a degree required to obtain Social Worker licensure in Ohio.
• Three years of experience in case management and/or managed care.
• Current, unrestricted Ohio licensure as a Registered Nurse (RN), Licensed Social Worker (LSW), or Licensed Independent Social Worker (LISW).
• Intermediate proficiency in Microsoft Office Suite.
• Basic knowledge of a Windows-based environment.
• Ability to operate a smartphone, iPad, or other mobile communication device.
• Excellent written and verbal communication skills.
• Ability to work with diverse populations in a non-judgmental manner.
• Ability to work independently and as part of a team.
• Strong organizational skills, excellent assessment skills, and attention to detail.
• Knowledge of Medicare and Medicaid.
• Critical thinking, listening, time management, customer service, decision-making, and problem-solving skills.
• Knowledge of evidence-based medical criteria and/or standards of care.

Nice To Haves

• Bachelor of Science in Nursing (BSN) or an equivalent baccalaureate degree in a healthcare field.
• Experience in a Medicare and/or Medicaid managed care environment.
• Post-acute, home care, waiver, or acute clinical care experience.
• Multi-state licensure.
• Case Management Certification (CCM).

Responsibilities

• Serve as a point of contact for care coordinators, waiver service coordinators, medical directors, providers, and other stakeholders as part of the interdisciplinary care team.
• Support coordination of level-of-care transitions involving long-term and respite nursing facility services and HCBS waiver services.
• Ensure timely nursing facility level-of-care reviews, respite request reviews, and HCBS waiver enrollment or disenrollment in accordance with regulatory and accreditation requirements.
• Verify member eligibility, prior enrollment history, and demographics during case reviews.
• Monitor and assist members in maintaining benefit eligibility during level-of-care transitions.
• Complete prospective and retrospective reviews of nursing facility level-of-care determinations, respite care requests, and waiver enrollment or disenrollment.
• Coordinate, oversee, and provide input in the clinical documentation system for requested services.
• Perform clinical functions related to level-of-care transitions and support appeals processes as requested.
• Gather clinical documentation with care coordinators, waiver service coordinators, providers, and other stakeholders.
• Coordinate care to facilitate timely and cost-effective nursing facility discharge planning.
• Review contacts, treatment plans, case notes, referrals, and assessments in the electronic medical record according to accreditation and compliance guidelines.
• Assist with developing and implementing care plans, including defining issues, prioritized goals, and interventions agreed upon by involved parties.
• Document and communicate with relevant stakeholders to coordinate care and establish safe transition plans when clinically appropriate.
• Collaborate with care coordinators and waiver service coordinators regarding changes in member eligibility or level-of-care determinations.
• Maintain knowledge of federal and state regulations, state contracts, provider agreements, and CareSource Medicare and Medicaid benefits, including HCBS and nursing facility services.
• Attend and participate in interdisciplinary team meetings, State Hearings, and Medical Advisement meetings when requested.
• Escalate care coordination needs to appropriate team members and leaders.
• Refer identified quality issues to Quality Improvement.
• Maintain documentation according to MyCare Program protocols and guidelines.
• Precept or mentor new staff.
• Participate in special projects or research as requested.
• Maintain required reporting and assist with data analysis as requested.
• Perform other job-related duties as requested.

Benefits

• Potential bonus tied to company and individual performance.
• Substantial and comprehensive total rewards package.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree