Transition Coordinator

Become a part of our caring community. The Transition Coordinator (Care Coach 2) evaluates members' needs and requirements to achieve and/or maintain optimal wellness by guiding members and families toward resources appropriate for their care and well-being.

Responsibilities

• Support ongoing member transitions in and out of Indiana Medicaid programs, contractor enrollment, and among care settings.
• Prepare for transitions and follow up on care after transitions are completed.
• Collaborate with the Member Advocate Coordinator and other member-focused departments to ensure continuity and coordination of care, including member and provider communication through transitions, benefit plans, 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, care management, and complex case management notes.
• Assist with transitions from custodial settings to home and community-based settings.
• Conduct telephonic and in-person meetings within the assigned region with long-term care members, hospital/rehab staff discharge planners, family members/POAs, PCPs, and other healthcare professionals to prevent custodial placements when possible.
• Assess and evaluate members' needs to establish member-specific care plans and coordinate services.
• Ensure members transition to the least restrictive setting to achieve or maintain well-being by assessing their care needs.
• Guide members and families toward appropriate resources and facilitate interactions with payer sources, providers, interdisciplinary teams, and others involved in the member's care.

Requirements

• Bachelor's degree in a 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.
• This role is patient-facing and requires participation in Humana's Tuberculosis (TB) screening program.
• Must have a valid state driver's license and maintain personal vehicle liability insurance with minimum required limits or $25,000 bodily injury per person/$25,000 bodily injury per event/$10,000 for property damage (or higher, depending on state requirements).
• Must have a separate room with a locked door for use as a home office to ensure privacy.
• Must reside in one of the following counties: Gibson, Perry, Posey, Spencer, Vanderburgh, or Warrick.

Preferred Qualifications

• Master's Degree.
• Applicable state license in field of study (e.g., RN).
• Case Management Certification (CCM).
• InterQual or Milliman experience.
• Prior experience with Medicare & Medicaid recipients.
• Experience with electronic case note documentation and 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

• Self-provided internet service must meet the following criteria: minimum download speed of 25 Mbps and upload speed of 10 Mbps; wired cable or DSL connection suggested.
• Work from a dedicated space lacking ongoing interruptions to protect member PHI/HIPAA information.

Travel

Occasional travel to Humana's offices for training or meetings may be required.

Schedule

Scheduled weekly hours: 40.

Pay

The pay range for this full-time position (40 hours per week) is $59,300 - $80,900 per year. This job is eligible for a bonus incentive plan based on company and/or individual performance.

Benefits

• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, including company and personal holidays, paid parental and caregiver leave.
• Short-term and long-term disability.
• Life insurance.