Transition Coordinator

driscoll; Victoria (TX); On-site; USD 52,000 - 78,000; Full time

Job summary

The STAR Kids Transition Coordinator at Health Plan leads transition planning for youth aging out of STAR Kids, coordinating a transition team and creating comprehensive plans to maximize independence.

You will collaborate with medical directors, Medicaid programs, and community-based providers, ensuring continuity of care and placement in integrated settings.

Qualifications

• Knowledge in Texas Medicaid criteria/guidelines preferred.
• Knowledge about managed care contracts/guidelines preferred.
• Knowledge of programs and services required to support the health and medical needs of disabled children preferred.
• Knowledge of various reimbursement mechanisms, including third party requirements preferred.
• Microsoft Office skills preferred.
• Maintains utmost level of confidentiality at all times.
• Maintains compliance with regulatory agencies that conduct intermittent reviews and audits to ensure contractual and regulatory compliance with Federal, State entities as well URAC.
• Implements and adheres to Health System and Health Plan policies and procedures for members with special health care needs (STAR Kids).
• Demonstrates business practices and personal actions that are ethical and adhere to Corporate Compliance and integrity guidelines.

Responsibilities

• Function in an advisory role to the Medical Directors and Medical Management Committee in the following areas:Provide evaluation of and assist in the development of quality patient care services offered by DCHP;Assist in the establishment of patient care and professional staff policies and procedures of DCHP; Participate in long-range planning of services and/or programs offered by DCHP.
• Assemble a transition team and develop a transition plan with an extensive array of activities to maximize independence and assist the youth in qualifying for the appropriate adult programs for those members who will be aging out of STAR Kids.
• Develop policies, informational material, resource guides, transition assessment, transition readiness, planning/integration into adult services, and transference and admissions support to adult services.
• Oversee and lead all transition activities from initial contact through final transition to STAR+PLUS or other community-based programs.
• Be knowledgeable about children's issues, transition activities, local community resources, Medicaid eligibility, guardianship issues, and working with individuals with complex needs and their families, STAR+PLUS, programs administered by the Department of Aging and Disability Services (DADS), TEA, Department of Assistive and Rehabilitation Services (DARS) and all other relevant state agencies and community-based organizations.
• Conduct a transition assessment that results in a continuity of care plan and checklist that captures all the youth's needs and all necessary and relevant activities are met with no breaks in service or medication availability.
• Identify adult healthcare providers and assist in transitioning member to new provider.
• Work with a nursing facility (NF) or intermediate care facility (ICF) to establish a permanency plan to relocate the Member back to the community setting of their cho

Skills

Medicaid criteria knowledge

Managed care contracts/guidelines

Children's services knowledge

Reimbursement mechanisms

Microsoft Office

Confidentiality

Regulatory compliance

Policies & procedures (STAR Kids)

Ethical practices

Job description

Where compassion meets innovation and technology and our employees are family.

General Purpose of Job:

The STAR Kids Transition Coordinator understands that the transition to adulthood is one of the most significant events in an individual's life, especially for individuals with disabilities receiving publicly funded services under a children's program. Federal and state public policies use different sets of eligibility criteria, new program service arrays, and limitations on nursing/attendant hours for adult programs which may offer less intensive services than children's programs. Preparing for adult transition requires significant early planning led by a transition coordinator who assembles a transition team and develops a transition plan with an extensive array of activities to maximize independence and assist the youth in qualifying for the appropriate adult programs. The STAR Kids Transition Coordinator will oversee and lead all transition activities from initial contact through final transition to STAR+PLUS, other HHSC programs or other community-based programs. The STAR Kids Transition Coordinator is committed to ensuring that all members live in the most integrated residential setting of their choice. In addition, the STAR Kids Transition Coordinator will work with the nursing facility or intermediate care facility to relocate the member back to the community setting of their choice.

Essential Duties and Responsibilities:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other reasonably related business duties as assigned by Health Plan leadership, as required

Knowledge, Skills and Abilities:

1. Knowledge in Texas Medicaid criteria/guidelines preferred.
2. Knowledge about managed care contracts/guidelines preferred.
3. Knowledge of programs and services required to support the health and medical needs of disabled children preferred.
4. Knowledge of various reimbursement mechanisms, including third party requirements preferred.
5. Microsoft Office skills preferred.
6. Maintains utmost level of confidentiality at all times.
7. Maintains compliance with regulatory agencies that conduct intermittent reviews and audits to ensure contractual and regulatory compliance with Federal, State entities as well URAC.
8. Implements and adheres to Health System and Health Plan policies and procedures for members with special health care needs (STAR Kids).
9. Demonstrates business practices and personal actions that are ethical and adhere to Corporate Compliance and integrity guidelines.

Responsibilities:

1. Function in an advisory role to the Medical Directors and Medical Management Committee in the following areas:
   • a. Provide evaluation of and assist in the development of quality patient care services offered by DCHP;
   • b. Assist in the establishment of patient care and professional staff policies and procedures of DCHP; and
   • c. Participate in long-range planning of services and/or programs offered by DCHP.
2. This position shall be responsible for the following aspects of the program:
   • a. Assemble a transition team and develop a transition plan with an extensive array of activities to maximize independence and assist the youth in qualifying for the appropriate adult programs for those members who will be aging out of STAR Kids.
   • b. Develop policies, informational material, resource guides, transition assessment, transition readiness, planning/integration into adult services, and transference and admissions support to adult services.
   • c. Oversee and lead all transition activities from initial contact through final transition to STAR+PLUS or other community-based programs.
   • d. Be knowledgeable about children's issues, transition activities, local community resources, Medicaid eligibility, guardianship issues, and working with individuals with complex needs and their families, STAR+PLUS, programs administered by the Department of Aging and Disability Services (DADS), TEA, Department of Assistive and Rehabilitation Services (DARS) and all other relevant state agencies and community-based organizations.
   • e. Conduct a transition assessment that results in a continuity of care plan and checklist that captures all the youth's needs and all necessary and relevant activities are met with no breaks in service or medication availability.
   • f. Identify adult healthcare providers and assist in transitioning member to new provider.
   • g. Work with a nursing facility (NF) or intermediate care facility (ICF) to establish a permanency plan to relocate the Member back to the community setting of their cho