Post-Acute Transitions Navigator

CareSource; Kentucky; Hybrid; USD 63,000 - 100,000; Full time

Job summary

CareSource is seeking a Transitions Coordinator- Post Acute to monitor member level of care transitions to long-term care, respite facilities, and HCBS waiver services through clinical review and benefits management. This role collaborates with the ICT, waiver service coordinators, and providers to ensure appropriate supports during transitions.

Key responsibilities include overseeing eligibility checks, regulatory compliance, and timely disposition of care transitions, with a focus on

Qualifications

• RN/LSW/LISW licensure in Ohio is required
• BSN or equivalent healthcare degree preferred
• Three years of experience in case management or managed care required
• Medicare/Medicaid managed care experience preferred
• Post-acute, home care, waiver, or acute clinical care experience preferred

Responsibilities

• Serve as a liaison within the interdisciplinary care team to support level of care transitions to long-term and respite facilities and HCBS waivers
• Ensure timely reviews and enrollment/disenrollment to maintain regulatory compliance
• Verify member eligibility, enrollment history, and demographics during case reviews
• Monitor benefit eligibility during transitions and maintain documentation in EMR
• Coordinate care planning and gather clinical documentation for level of care transitions
• Assist with development and implementation of care plans and safe transition strategies

Skills

Interdisciplinary collaboration

Communication skills

Time management

Attention to detail

Critical thinking

Independent work

Education

RN, LSW, or LISW licensure in Ohio

BSN preferred

CCM certification preferred

Tools

Microsoft Office

EMR systems

Job description

CareSource is seeking a Transitions Coordinator- Post Acute to monitor member level of care transitions to long-term care, respite facilities, and HCBS waiver services through clinical review and benefits management. This role collaborates with the ICT, waiver service coordinators, and providers to ensure appropriate supports during transitions.

Key responsibilities include overseeing eligibility checks, regulatory compliance, and timely disposition of care transitions, with a focus on