Care Transition Specialist II BWH

Brigham and Women's Hospital; Boston (MA); Hybrid; USD 60,000 - 85,000; Full time

Job summary

Brigham and Women's Hospital seeks a Care Transition Specialist II who will provide administrative support in care coordination, advocate for patients, and help ensure high-quality care. This role involves direct interaction with patients, caregivers, and the healthcare team to facilitate seamless care transitions.

Qualifications

• Health care experience in extended care facilities preferred.
• 7-10 years of experience in a healthcare setting can substitute for a degree.
• Bilingual preferred.

Responsibilities

• Provides direct administrative support related to continuum of care.
• Communicates with insurance companies to manage authorization delays.
• Secures medical records needed for treatment planning.

Skills

Assessment and problem-solving skills

Strong interpersonal skills

Customer service skills

Ability to work independently

Organizational skills

Time management skills

Strong oral communication skills

Strong written communication skills

Education

Associate degree required

Bachelor’s Degree preferred

Job description

Care Transition Specialist II BWH page is loaded

Care Transition Specialist II BWH

Apply remote type Hybrid locations Boston-MA time type Full time posted on Posted 7 Days Ago job requisition id RQ4023254 Site: The Brigham and Women's Hospital, Inc.

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham.

Care Transition Specialist II - 40 hour Rotating - BWH CCM Care Coordination

Job Summary

The Care Transition Specialist works collaboratively with Care Coordination to complete administrative responsibilities related to care progression and care transitions along the continuum of care. They work collaboratively with nurse care coordinators, social workers, physicians, and other care team members. The Care Transition Specialist is responsible for acting as an advocate for patients and patient families and strives to support Brigham Health’s aim for high quality care, high customer satisfaction, and optimal resource management. The person in this position will spend time on the clinical units and have direct interaction with patients and their families, clinical and ancillary hospital staff, and other internal and external customers.

1. Provides direct administrative support to the care team, patients, and patients’ caregivers related to continuum of care:

a. Supports the administrative tasks and communication related to post discharge care, including referrals to internal and external resources, such as rehabilitation facilities, home health agencies, hospice, durable medical equipment (DME) providers, and other vendors.
b. Actively manages 4Next referrals along the continuum of care, including communication with facilities, agencies, and vendors to promote patient progression to support discharge and effective transitions of care.
c. Secures DME and oxygen for post-acute needs; maps insurance and geography to identify appropriate vendors assesses insurance benefits and coordinates the necessary paperwork with the external vendors and medical team for approval for equipment, such as letters of medical necessity, medical record documentation, and prescriptions. Arranges for and tracks/confirms delivery of equipment prior to or post-discharge.
d. Performs administrative tasks to support the medication prior-authorization function, including completion of forms, securing medical necessity information, and helping to support mitigate barriers for discharge.
e. Assists with the completion of patient follow-up appointments (specialty and PCP) for follow-up care needs.
f. Secures medical records from outside hospital needed to help determine the Acute treatment plan, including outreach to outside hospitals, completion of forms, securing consent from patient or family and securing outside medical record content.
g. Communicates with insurance companies to expedite and/or manage delays with authorization for post-acute care and services or query for covered services
h. Distributes and documents key forms and documents to comply with regulations, including Medicare Important Message and Medicare Outpatient Observation Notice. And prepares and submits Medicare Appeal documentation as needed.
i. Arranges all types of patient transportation under the direction of the care team, including Med Flight, ALS, BLS, Chair Car, Circulation, Care Van or Cab Vouchers.
j. Submission of longitudinal transport requests, including MassHealth PT-1 and The Ride Applications for patients meeting requirements.
k. Participates in family meetings and interdisciplinary huddles to solicit and provide input related to their responsibilities.
l. Accesses and navigates the electronic medical record to obtain essential information, documents progress notes and Resource Specialist Quick Notes as per department standards.
m. Researches and secures out of state and in-network VNAs and facilities.
n. Initiates and/or completes regulatory and other forms, such as MassHealth Long-Term Care and DMH/DDS PASSR forms and processes the completed forms with the appropriate agencies.
o. Completes administrative documentation under the direction of the care team.
p. Escalates barriers to discharge.

2. Collects, confirms and verifies key patient information (i.e., demographics, health care proxy, benefit verification, and patient preferences for pharmacy, facilities, VNA, etc).

3. Maintains knowledge and reference materials on key resources available to patients and patients’ caregivers across the continuum:

a. Acts as a knowledge resource for post-acute care resources, included but not limited to, insurance requirements, facility attributes, contact information, etc.
b. Identifies and refers patients to community services (i.e. transportation, food programs, day programs, and financial programs).
c. Communicates, consults and collaborates with a wide range of agencies and ambulatory practices under the direction of the care team.
d. Private care options.

Qualifications

• Associate degree required

• Bachelor’s Degree preferred

• Health care experience, preferably in extended care facilities and community agencies, preferred

• Preferred experience in hospital discharge planning, long term care facility, community health or utilization review preferred

• Bilingual preferred

Can this role accept experience in lieu of a degree?

Yes, 7-10 years of experience in a healthcare setting

Knowledge, Skills and Abilities
- Assessment and problem-solving skills.
- Strong interpersonal skills.
- Strong Customer service skills.
- Ability to work independently with minimal supervision.
- Goal oriented and accountable in a complex medical environment.
- Experience navigating Insurance Networks desired.
- Demonstrated organizational and time management skills.
- Strong oral and written communication skills.
- Good computer experience.

Additional Job Details (if applicable)

Working hours:

8:00 am - 4:30 pm
8:30 am - 5:00 pm

Weekend and holiday rotation required, 8:00 am - 4:30 pm

Hybrid schedule may change due to the needs of the healthcare facility and operations. Weekend and holiday shifts are required to be on-site.

Remote Type

Hybrid

Work Location

45 Francis Street

Scheduled Weekly Hours

40

Employee Type

Regular

Work Shift

Rotating (United States of America)

EEO Statement:

The Brigham and Women's Hospital, Inc. is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. To ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veteran’s Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants who require accommodation in the job application process may contact Human Resources at (857)-282-7642.

Mass General Brigham Competency Framework

At Mass General Brigham, our competency framework defines what effective leadership “looks like” by specifying which behaviors are most critical for successful performance at each job level. The framework is comprised of ten competencies (half People-Focused, half Performance-Focused) and are defined by observable and measurable skills and behaviors that contribute to workplace effectiveness and career success. These competencies are used to evaluate performance, make hiring decisions, identify development needs, mobilize employees across our system, and establish a strong talent pipeline.

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