Transition Coordinator

Position: Transition Coordinator

Duration: 3 Months

Shift Time: Monday Friday 8:00am5:00pm MST

Location: Remote

Job Summary:

• Candidate must be comfortable working in MST time zone.
• Must have experience with Member or Patients discharge.
• Position Purpose:
• Ensure the timely and safe transition of members into or out of the health plan.
• Assist in the transition of members back into the community from various levels of health care services.

Education/Experience:

• Bachelors degree in Social Work Nursing Health Behavioral Science or equivalent experience.
• 3 years of related experience.
• Experience working with Medicaid recipients with physical developmental and intellectual disabilities and/or behavioral health conditions.
• Experience in insurance and utilization review.

Responsibilities:

• Manage the transition of care for members enrolling or exiting the health plan.
• Identify new enrollee requiring transition of care services.
• Complete assessment of the new Enrollees health care needs
• Determine the presence of active care needs or possible outstanding service authorizations.
• Identify the Enrollees previous MCO (if applicable)
• Contact the previous MCO and/or Primary Care Provider (PCP) to obtain relevant Enrollee information (if applicable)
• Ensure existing authorizations with previous health plan or in feeforservice are honored during the transition for a minimum of 60 calendar days from the date of enrollment in the health plan.
• Assist the enrollee with continuing authorization of medically necessary services transitions into Integrated Care Program transitions between MCOs and transitions to private insurance or no coverage.
• Coordinate care plans with community care coordinators and the enrollee.
• Educate transitioning enrollees about services requirements limitations and/or exclusions of services because of the transition.

daytoday responsibilities:

• Transition Coordinator will be notified when a member has admitted to the hospital they will call hospitals (Behavioral Health and Physical Health) to attempt to engage member prior to discharge and hospital discharge planner to begin to plan for members successful discharge.
• Post Member discharge Transition Coordinator is required to reach out directly to member telephonically within 3 calendar days of discharge to engage in Transition of Care process.
• Transition of Care Coordinator would address the below required topics with Member to assess members discharge needs and identify any barriers that member will need assistance with.
• Transition Coordinator will make their first attempt within the 3 calendar days and make a total of 3 attempts on different dates/times (one afterhours) within 10 calendar days. If a member agrees to Transition of Care support Member will be called monthly for 3 months to continue to assess needs and provide support. After the 3rd month Member will be offered to continue with Care Coordination if needed and if the refuse then all contact will end at that time.
• The Transition Coordinator will be assigned new members to call every day.
• Safety in Home Environment: Document discussion
• Physical Health Needs (Follow up appts therapies and treatments Meds DME): Document discussion PCP engagement transportation needs.
• Behavioral Health Needs (Follow up appts): Document discussion. Specifically speak to 7day followup appointment FUH Gift Card incentive transportation needs Teambuilders postdischarge clinical call.
• Housing Needs: Document discussion
• Continuation of Medicaid Eligibility: Document discussion
• Financial Needs: Document discussion
• Interpersonal Skills (verbal listening written and nonverbal communication): Document discussion.
• Selection of Providers in the Community: Document discussion
• CNA if one is not in place: Document discussion.
• Community Benefit needs and services in place: Document discussion
• Do you need assistance with 2 or more ADLs/IADLs
• Is your need for assistance being met today
• Do you need or are you interested in Longterm Support Services