Post-Acute Transitions Specialist

CareSource Management Services; Ohio; Hybrid; USD 65,000 - 90,000; Full time

Job summary

CareSource Management Services is seeking a Transitions Coordinator- Post Acute. This role oversees member transitions to and from long-term care, respite facilities, and HCBS waivers, partnering with care teams to ensure appropriate supports throughout the transition.

Qualifications include RN degree and 3 years in case management or managed care. BSN preferred; Medicare/Medicaid experience is a plus. Strong organizational and communication skills are essential.

Qualifications

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

Responsibilities

• Acts as point of contact with the Care Coordinator, Waiver Service Coordinator, Medical Director, Provider, or other stakeholders to support coordination of level of care transitions.
• Ensures timely nursing facility-based level of care completion and HCBS waiver enrollment/disenrollment to maintain compliance.
• Verifies eligibility, previous enrollment history, and demographics of members during case reviews.
• Monitors and assists members to maintain benefit eligibility during level of care transitions.
• Completes prospective and retrospective reviews for NF level of care, respite care, and waiver enrollment/disenrollment.
• Coordinates and provides input in the clinical documentation system for requested services.
• Supports appeals processes as requested and monitors regulatory compliance.
• Coordinates with care coordinators, waiver coordinators, and providers to gather clinical documentation for transitions.
• Facilitates NF discharge planning in a timely and cost-effective manner.
• Reviews documentation in electronic medical records per accreditation and compliance guidelines.

Skills

Microsoft Office

Communication skills

Teamwork

Organizational skills

Assessment

Education

RN degree

BSN preferred

State licensure eligibility

Job description

CareSource Management Services is seeking a Transitions Coordinator- Post Acute. This role oversees member transitions to and from long-term care, respite facilities, and HCBS waivers, partnering with care teams to ensure appropriate supports throughout the transition.

Qualifications include RN degree and 3 years in case management or managed care. BSN preferred; Medicare/Medicaid experience is a plus. Strong organizational and communication skills are essential.