Description: Job Profile Summary
Position Purpose:
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.
Education/Experience:
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.
License/Certification:
For Health Net of California LVN/LPN State Licensure required required
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
Custom Fields:
Name: Shortlisting Date
Value: None
Name: Field Worker
Value: Yes
Name: If this request is replacing a previously canceled request, please provide the original Request ID
Value: None
Name: Which Health Plan, programs or functions will this work support?
Value: Buckeye Community Health Plan