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The Transition Coordinator (Care Coach 2) evaluates member's needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources 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.
Position Responsibilities:
- Supports and oversees the initial and ongoing member transitions in and out of the various Indiana Medicaid programs, the Contractor's enrollment, and among care settings.
- Assists with the planning and preparation for transitions and the follow-up care after transitions are completed.
- Works with the Member Advocate Coordinator and other member-focused departments of the plan to ensure continuity and coordination of care and member and provider communication through the initial transition, ongoing benefit plan, and MCE transfers.
- Ensures 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.
- Assist with transitions from the custodial setting to the home and community based setting.
- Requires telephonic and in-person meetings within assigned region to meet with the long term care members, hospital/rehab staff discharge planners, family members/POA's PCP's, and other health care professionals in order to prevent custodial placements when possible
- Assesses and evaluates member's needs and requirements in order to establish a member specific care plan and coordinates services
- Ensures members are transitioning to the least restrictive setting in order to achieve and/or maintain optimal well being by assessing their care needs
- Guides members/families towards resources appropriate for their care. Services are driven by facilitating interactions with other payer sources, providers, interdisciplinary teams and others involved in the member's care as appropriate and required by our comprehensive contract.
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Required Qualifications:
Transition Coordinators (Care Coach 2) shall meet one of the following qualifications:
- Registered nurse, a licensed practical nurse, or an associate's degree in nursing with at least one (1) year of experience serving the program population; OR
- Bachelor's degree in Social Work, Psychology, Counseling, Gerontology, Nursing or Health & Human Services; OR
- Bachelor's degree in any field with a minimum of two (2) years full-time, direct service experience with older adults or persons with disabilities (this experience includes assessment, care plan development, and monitoring); OR
- Master's degree in Social Work, Psychology, Counseling, Gerontology, Nursing or Health & Human Services; OR
- Associate's degree in any field with a minimum of four (4) years full-time, direct service experience with older adults or persons with disabilities (this experience includes assessment, care plan development, and monitoring). OR
- Minimum 6 years professional human services experience.
Must meet all following requirements:
- Prior experiences in health care and/or case management.
- Intermediate to advanced computer skills and experience with Microsoft Word, Excel, and Outlook.
- Exceptional communication and interpersonal skills with the ability to build rapport with internal and external customers and stakeholders.
- Proven ability of critical thinking, organization, written and verbal communication and problem- solving skills.
- Ability to manage multiple or competing priorities in a fast-paced environment.
- Ability to use a variety of electronic information applications/software programs including electronic medical records.
- Must Reside in Indiana (member facing position)
Preferred Qualifications:
- Applicable state license in field of study
- Bilingual (English/Spanish)
- Prior nursing home diversion or long-term care case management experience
- Prior experience with Medicare & Medicaid recipients
- Experience with electronic case note documentation and documenting in multiple computer applications/systems.
- Experience working with geriatric population.
- Experience with health promotion, coaching and wellness.
- Knowledge of community health and social service agencies and additional community resources
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$57,700 - $79,500 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.