Transition Coordinator

About the role

Become a part of our caring community

The Transition Coordinator (Care Coach 2) evaluates member's needs and requirements. This evaluation aims to achieve and/or maintain an optimal wellness state. The Coordinator guides members/families toward resources and facilitates interaction with them. These resources are 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

• 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

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

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.

$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.