Transition Coordinator

Become a part of our caring community The Transition Coordinator (Care Coach 2) evaluates member's needs and requirements to achieve and/or maintain optimal wellness state. This is done by guiding members/families toward and facilitating 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 Support the ongoing member transitions in and out of the Indiana Medicaid programs, the Contractor's enrollment, and among care settings. Helps prepare for transitions and follows up on care after completing transitions. Works with the Member Advocate Coordinator and other member-focused departments of the plan to ensure continuity and coordination of care. This collaboration also ensures member and provider communication through the initial transition, ongoing benefit plan, and MCE transfers. Ensure 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. Help with transitions from the custodial setting to the home and community-based setting. We are looking for telephonic and in-person meetings within the assigned region. These meetings involve meeting with long-term care members, hospital/rehab staff discharge planners, family members/POA's, PCP's, and other health care professionals. The goal of these meetings is to prevent custodial placements when possible. Assess and evaluate member's needs to establish a member specific care plan and coordinates services Ensure members are transitioning to the least restrictive setting to achieve or maintain well being by assessing their care needs Guide members/families towards resources appropriate for their care. Facilitate interactions with other payer sources, providers, interdisciplinary teams and others involved in the member's care and required by our comprehensive contract to lead services. Use your skills to make an impact. Required Qualifications Bachelor's degree in health and human services field 2 or more years of relevant experience Must be passionate about contributing to an organization focused on improving consumer experiences We consider this role patient facing and Humana's Tuberculosis (TB) screening program includes it. If selected for this role, we will require you to screen for TB. This role belongs to Humana's driver safety program and therefore Humana requires an individual to have a valid state driver's license and expects them to maintain personal vehicle liability insurance. Individual must carry vehicle insurance following their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher Must have a separate room with a locked door that can be used as a home office to ensure privacy while you work You will live in the area you serve. You must reside in one of the following counties: Gibson, Perry, Posey, Spencer, Vandenburg, or Warrick Preferred Qualifications Master's Degree Applicable state license in field of study (RN) Case Management Certification (CCM) Interqual or Millman experience Prior experience with Medicare & Medicaid recipients Previous experience with electronic case note documentation and experienced with documenting in multiple computer applications Experience with health promotion, coaching and wellness Knowledge of community health and social service agencies and additional community resources Work at Home Requirements To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. In certain roles, the minimum recommended internet speed required by Humana may not be sufficient for business needs. Humana reserves the right to require associates to upgrade their internet service if necessary. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range 59,300 - 80,900 per year 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our 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 and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer atHumana.comand atCenterWell.com. 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 protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with 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. #J-18808-Ljbffr Humana Inc