Care Transitions Specialist - Hybrid (Travel)

Molina Healthcare; Olympia (WA); Hybrid; USD 36,000 - 82,000; Full time

Job summary

Molina Healthcare is seeking a licensed Behavioral Health Transition of Care Coordinator to support Medicaid members transitioning from psychiatric hospital stays. This hybrid role requires home office work with local hospital visits to ensure discharge planning excellence, reduce readmissions, and connect members with needed services.

Responsibilities include coordinating with discharge teams, conducting in-hospital and home visits, and applying the Coleman Care Transition model to improve

Qualifications

• 2+ years experience in health care, with at least 1 year in discharge planning, care management or behavioral health setting.

Responsibilities

• Follows member through a 30 day program from hospital admission through transitions to other settings to reduce readmissions.
• Collaborates with hospital discharge planners, hospitalists, outpatient providers, facility staff, and family to ensure safe transitions.
• Ensures transitions to settings with appropriate caregiving, medical and medication oversight.
• Works with ancillary providers and public agencies to arrange necessary services and equipment.
• Performs face-to-face visits in hospital and home visits for high-risk members post-discharge.
• Coordinates care and reassesses needs using the Coleman Care Transition model.
• Educates members on medication management, health records, follow-up care, warning signs, nutrition, functional needs and community services.
• Uses motivational interviewing and Molina clinical guideposts to support and motivate change.
• Identifies barriers to care and provides care coordination assistance.
• Facilitates interdisciplinary care team meetings and consultations with non-behavioral health managers.
• Local travel 40-50% may be required.

Skills

Care coordination

Discharge planning

Care management

Communication

Time management

Self-motivation

Interdisciplinary collaboration

Travel readiness

Education

LCSW

LMSW

APSW

CHES

LPC

LPCC

LMFT

PhD

PsyD

Tools

Microsoft Office

Job description

Molina Healthcare is seeking a licensed Behavioral Health Transition of Care Coordinator to support Medicaid members transitioning from psychiatric hospital stays. This hybrid role requires home office work with local hospital visits to ensure discharge planning excellence, reduce readmissions, and connect members with needed services.

Responsibilities include coordinating with discharge teams, conducting in-hospital and home visits, and applying the Coleman Care Transition model to improve