Hybrid Care Transition & Discharge Coach

Jobtome; Long Beach (CA); Hybrid; USD 36,000 - 82,000; Full time

Benefits offered by this job

Mileage reimbursement

Job summary

Molina Healthcare is seeking a licensed behavioral health clinician to serve as a Transition of Care Coordinator for Medicaid members recently discharged from psychiatric hospitals. The position combines work from a home office with local travel to hospitals to coordinate discharge and services.

Responsibilities include overseeing a 30-day transition, collaborating with discharge planners and care teams, and educating members on medications and follow-up care to reduce readmissions.

Qualifications

• Licensed behavioral health clinician with active license in state of practice.
• 2+ years in health care with hospital discharge planning or care management experience.

Responsibilities

• Provide transitional care coordination from hospital admission through discharge to other settings.
• Collaborate with hospital discharge planners, hospitalists, outpatient providers, facility staff and families.
• Conduct face-to-face and home visits for high-risk members post-discharge.
• Coordinate care using Coleman Care Transition model post-discharge.
• Educate members on transition pillars: medication management, follow-up care, signs of worsening condition, nutrition, functional needs, and home/community services.

Skills

Care coordination

Discharge planning

Behavioral health

Communication

Time management

Microsoft Office

Education

Licensed Behavioral Health Clinician (LCSW/LMSW/APSW/CHES/LPC/LPCC/LMFT/PhD/PsyD)

Tools

Microsoft Office

Job description

Molina Healthcare is seeking a licensed behavioral health clinician to serve as a Transition of Care Coordinator for Medicaid members recently discharged from psychiatric hospitals. The position combines work from a home office with local travel to hospitals to coordinate discharge and services.

Responsibilities include overseeing a 30-day transition, collaborating with discharge planners and care teams, and educating members on medications and follow-up care to reduce readmissions.