Post-Acute Care Transitions Navigator

CareSource; Columbus (OH); On-site; USD 63,000 - 100,000; Full time

Job summary

CareSource in Columbus, Ohio, seeks a Transitions Coordinator- Post Acute to oversee member level of care transitions from long-term care, respite nursing facilities, and HCBS waivers, coordinating with care teams to ensure appropriate supports.

The role requires reviewing eligibility, completing level of care determinations, and coordinating with providers and staff for timely discharge planning while maintaining compliance.

Qualifications

• Completion of an accredited RN degree program or degree required to obtain Social Worker licensure in the State of Ohio.
• BSN in Nursing or equivalent preferred.
• Three years of experience in case management and/or managed care.
• Experience in Medicare and/or Medicaid managed care environment preferred.
• Post-acute, home care, waiver, or acute clinical care experience preferred.

Responsibilities

• Acts as point of contact with Care Coordinator, Waiver Service Coordinator, Medical Director, Provider, and stakeholders to support ICT care coordination.
• Ensure timely nursing facility-based level of care reviews and HCBS waiver enrollment/disenrollment for compliance.
• Verify eligibility, enrollment history, and demographics during case reviews.
• Monitor and assist members to maintain benefit eligibility during transitions.
• Complete prospective and retrospective reviews of requests for NF level of care determinations and waiver enrollment.
• Coordinate and provide input in the clinical documentation system for requested services.
• Support clinical functions related to level of care transition processes and appeals as needed.
• Gather clinical documentation with stakeholders to complete level of care transitions.
• Coordinate care with providers to facilitate NF discharge planning in a timely, cost-effective manner.
• Review EMR documentation according to accreditation and compliance guidelines.
• Assist with care plan development by defining issues, goals, and interventions.
• Document and communicate with Health Partners, Care Coordinators, and others to establish safe transition plans.
• Collaborate with teams on changes in eligibility or level of care determinations.
• Maintain knowledge of federal/state regulations governing CareSource benefits and HCBS services.
• Attend interdisciplinary team meetings and hearings when requested.
• Escalate care coordination needs to appropriate team members.
• Identify and refer quality issues to Quality Improvement.
• Maintain documentation following MyCare program protocols.
• Precept and mentor new staff.
• Participate in special projects or data analysis as requested.

Skills

MS Office

Communication

Time management

Organizational skills

Critical thinking

Teamwork

Attention to detail

Medicare knowledge

Education

RN degree

LSW/LISW licensure Ohio

BSN preferred

CCM certification preferred

Tools

EMR system

Job description

CareSource in Columbus, Ohio, seeks a Transitions Coordinator- Post Acute to oversee member level of care transitions from long-term care, respite nursing facilities, and HCBS waivers, coordinating with care teams to ensure appropriate supports.

The role requires reviewing eligibility, completing level of care determinations, and coordinating with providers and staff for timely discharge planning while maintaining compliance.