Transition Coordinator
Company: Oklahoma Complete Health
Location: Lawton
Posted on: November 20, 2023
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Job Description:
You could be the one who changes everything for our 28 million
members as a clinical professional on our Medical Management/Health
Services team. Centene is a diversified, national organization
offering competitive benefits including a fresh perspective on
workplace flexibility.
Position Purpose: Ensure the timely and safe transition of members
into or out of the health plan. Assist in the transition of members
back into the community from various levels of health care
services.
Manage the transition of care for members enrolling or exiting the
health plan
Identify new enrollee requiring transition of care services
Complete assessment of the new Enrollee's health care needs
Determine the presence of active care needs or possible outstanding
service authorizations
Identify the Enrollee's previous MCO (if applicable)
Contact the previous MCO and/or Primary Care Provider (PCP) to
obtain relevant Enrollee information (if applicable)
Ensure existing authorizations with previous health plan or in
fee-for-service are honored during the transition, for a minimum of
60 calendar days from the date of enrollment in the health plan
Assist the enrollee with continuing authorization of medically
necessary services, transitions into Integrated Care Program,
transitions between MCOs, and transitions to private insurance or
no coverage.
Coordinate care plans with community care coordinators and the
enrollee
Educate transitioning enrollees about services, requirements,
limitations and/or exclusions of services as a result of the
transition.
Education/Experience: Bachelor's degree in Social Work, Nursing,
Health, Behavioral Science or equivalent experience. 3+ years of
related experience. Experience working with Medicaid recipients
with physical, developmental and intellectual disabilities and/or
behavioral health conditions. Experience in insurance and
utilization review.
License/Certification: Valid driver's license. Social Worker, LPN,
LVN, or RN preferred.
For LA Healthcare Connections only - Valid driver's license
preferred.:
For PA Health & Wellness plan: RN or LPN license required.
For North Carolina only: In addition, these individuals will assist
members who are moving from one clinical setting to another to
prevent unplanned or unnecessary readmissions, emergency department
visits, or adverse outcomes. Must reside in NC.
Our Comprehensive Benefits Package: Flexible work solutions
including remote options, hybrid work schedules and dress
flexibility, Competitive pay, Paid time off including holidays,
Health insurance coverage for you and your dependents, 401(k) and
stock purchase plans, Tuition reimbursement and best-in-class
training and development.
Centene is an equal opportunity employer that is committed to
diversity, and values the ways in which we are different. All
qualified applicants will receive consideration for employment
without regard to race, color, religion, sex, sexual orientation,
gender identity, national origin, disability, veteran status, or
other characteristic protected by applicable law.
Keywords: Oklahoma Complete Health, Lawton , Transition Coordinator, Other , Lawton, Oklahoma
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