Transitions Coordinator - Post Acute-4

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

Job Summary:

The Transitions Coordinator- Post Acute is responsible for monitoring and managing the functions related to member level of care transitions to and from long-term care, respite nursing facility services, and the enrollment or disenrollment of home and community based (HCBS) waiver services through clinical review and benefits management. The Coordinator partners with care coordination and waiver service coordination staff in addition to other stakeholders to ensure members receive appropriate supports and services throughout the transition process.

Essential Functions:

• Acts as point of contact with the Care Coordinator, Waiver Service Coordinator, Medical Director, Provider, or other stakeholders to function in a collaborative role as a member of the interdisciplinary care team (ICT) to support coordination of level of care transitions related to long-term and respite nursing facility services and HCBS waiver services.
• Ensures timely nursing facility-based level of care completion, respite request reviews, and/or HCBS waiver enrollment/disenrollment to maintain compliance with regulatory and accreditation regulations.
• 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 review of requests for NF level of care determinations, respite care, and waiver enrollment or disenrollment per established processes.
• Coordinates, oversees, and provides input in the clinical documentation system for requested services per established processes.
• Responsible for clinical functions related to level of care transition processes; supports appeals processes as requested.
• Coordinates with the Care Coordinator, Waiver Service Coordinator, provider, and/or other stakeholders to gather clinical documentation to complete level of care transition processes.
• Coordinates care with care coordinators, waiver service coordinators, providers, and/or other stakeholders to facilitate NF discharge planning in a timely and cost-effective manner.
• Reviews current documentation of contacts, treatment plans, case notes, referrals, and assessments in the electronic medical record according to current accreditation and compliance guidelines.
• Assists with development and implementation of care plans as needed, by defining specific issues, prioritized goals and interventions as agreed to by all parties.
• Documents, identifies and communicates with Health Partners, Care Coordinators, Waiver Service Coordinators, Medical Directors, Discharge Planners, Providers and/or other stakeholders as needed for care coordination and to establish safe transition plans between levels of care when clinically appropriate.
• Closely collaborates with care coordinators and waiver service coordinators for any identified changes in eligibility for a member’s assessed level of care and/or with any changes in level of care determinations identified by providers or other external stakeholders.
• Maintains knowledge of federal and state regulations governing CareSource, State Contracts and Provider Agreements, and CareSource Medicare and Medicaid benefits (including HCBS and nursing facility-based services).
• Attends and participates in interdisciplinary team meetings, State Hearings, and/or Medical Advisement meetings, when requested.
• Escalates identified care coordination needs to the appropriate care coordination and/or waiver service coordination team member(s) and leader(s).
• Identifies and refer quality issues to Quality Improvement.
• Maintains appropriate documentation following protocols and guidelines of the MyCare Program.
• Precepts and/or mentors new staff.
• Participates in special projects or research, as requested.
• Maintains required reporting and assists with data analysis, as requested.
• Performs any other job related duties as requested.

Education and Experience:

• Completion of an accredited Registered Nurse (RN) degree program or degree required to obtain Social Worker licensure in the State of Ohio is required
• Bachelor of Science (B.S) in Nursing (BSN) or equivalent baccalaureate degree in healthcare field preferred
• Three (3) years of experience in case management and/or managed care required
• Experience in Medicare and/or Medicaid managed care environment is preferred
• Post-acute, home care, waiver, or acute clinical care experience is preferred

Competencies, Knowledge and Skills:

• Intermediate proficiency in Microsoft Office Suite
• Basic level knowledge of a Windows based environment
• Ability to operate smart phone, iPad, or other mobile communication devices to ensure productivity and ability to perform essential functions
• Excellent written and verbal communication skills
• Demonstrated ability to work with diverse populations in a non-judgmental manner
• Ability to work independently and within a team
• Strong organizational skills
• Excellent assessment skills
• Attention to detail
• Knowledge of Medicare and Medicaid
• Critical thinking and listening skills
• Time management skills
• Customer service oriented
• Decision making/problem solving skills
• Knowledge of evidence-based medical criteria and/or standards of care

Licensure and Certification:

• Current, unrestricted Registered Nurse (RN), Licensed Social Worker (LSW), or Licensed Independent Social Worker (LISW) licensure in state of Ohio is required
• Multi-state licensure is preferred
• Case Management Certification (CCM) is preferred

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Attendance at in-person meeting may be required
• Travel is not typically required

Compensation Range:

$62,700.00 - $100,400.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Salary

Organization Level Competencies:

• Fostering a Collaborative Workplace Culture
• Cultivate Partnerships
• Develop Self and Others
• Drive Execution
• Influence Others
• Pursue Personal Excellence
• Understand the Business

This job description is not all inclusive.

CareSource reserves the right to amend this job description at any time.

CareSource is an Equal Opportunity Employer.

We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.