Transition of Care Coordinator II

About the role

The Transitions of Care Coordinator II (TOC Coordinator II) is an experienced non-clinical care coordinator responsible for managing complex transitions of care for Medicare Advantage members following inpatient admissions, emergency department visits, skilled nursing facility stays, and other qualifying transitions.

Responsibilities

• Independently coordinate transitions of care activities for members with moderate to complex non-clinical care coordination needs.
• Conduct timely outreach to members and caregivers following qualifying transitions to facilitate post-discharge follow-up and continuity of care.
• Carefully coordinate primary care, specialty care, behavioral health, home health, pharmacy, transportation, interpreter services, durable medical equipment, and other post-discharge services.
• Obtain and organize discharge summaries, medical records, provider documentation, and other clinical information necessary to support the interdisciplinary care team.
• Identify barriers to care including transportation, housing instability, food insecurity, financial concerns, language needs, caregiver support, and access to community resources.
• Coordinate referrals to internal Population Health programs including Transitions of Care, Complex Case Management, Disease Management, Behavioral Health, Social Work, and Community Resource programs.
• Collaborate with hospitals, physician offices, skilled nursing facilities, home health agencies, pharmacies, and community organizations to facilitate seamless care transitions.
• Maintain confidentiality of protected health information in accordance with HIPAA and organizational policies.
• Maintain current knowledge of Medicare Advantage requirements, transitions of care workflows, and organizational policies.

Qualifications

• High school diploma or GED required.
• Associate degree in Healthcare Administration, Health Sciences, Social Services, Business, or related field preferred.
• Minimum of three (3) years of experience in healthcare, managed care, care coordination, case management support, medical office operations, or a related healthcare environment.
• Minimum of three (3) years of experience coordinating care for Medicare Advantage or managed care populations preferred.
• Experience supporting quality improvement initiatives, mentoring staff, or participating in workflow improvement activities preferred.
• Experience working in telephonic care coordination or call center operations preferred.
• Advanced knowledge of Medicare Advantage operations, CMS requirements, and transitions of care processes.
• Strong understanding of healthcare terminology, discharge planning, and care coordination principles.
• Demonstrated ability to independently manage a complex workload while meeting productivity and quality expectations.
• Ability to identify barriers to care and coordinate appropriate non-clinical interventions and community resources.
• Strong organizational, time management, and problem-solving skills with the ability to prioritize multiple assignments.
• Excellent verbal, written, and interpersonal communication skills with members, caregivers, providers, and interdisciplinary teams.
• Demonstrated ability to mentor, coach, and support less experienced staff.
• Ability to recognize situations requiring clinical intervention and appropriately escalate concerns to licensed clinical staff.
• Proficiency using electronic health records, care management platforms, Microsoft Office Suite, and virtual communication technologies.
• Ability to identify workflow improvement opportunities and contribute to departmental process improvement initiatives.
• Commitment to member-centered service, teamwork, professionalism, cultural competence, and continuous learning.
• Bilingual in Mandarin/Cantonese, Vietnamese, Korean, or Spanish preferred.