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 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. 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. Required Qualifications Use your skills to make an impact Bachelor's degree in health and human services field 2 or more years of relevant experience Intermediate to advanced proficiency with Microsoft Word, Excel and Outlook Detail oriented and comfortable working with tight deadlines in a fast paced environment Strong verbal and written communication skills Must be passionate about contributing to an organization focused on continuously improving consumer experiences This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB. This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with 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 continuous privacy while you work For this position you must serve the community you reside in. You must reside in one of the following Indiana counties: Cass, Fulton, Howard, Miami, Tipton, or Wabash Preferred Qualifications Master's Degree Applicable state license in field of study 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/systems Experience with health promotion, coaching and wellness Knowledge of community health and social service agencies and additional community resources Additional Information 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 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, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About Us About Humana: 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, 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