Transition Specialist

Position Title : Transition Specialist

Work Location : Fully Remote (Team sits in Texas. Rare 1-2 day summit annually).

Assignment Duration : 4 months (Contract to Hire)

Work Arrangement : Fully Remote

Position Summary :

Due to the redistribution of members and workload, each team member is now managing caseloads exceeding 1,000-well above the recommended threshold-posing significant challenges to meeting deadlines and maintaining performance.

Provides support with identifying, overseeing, and managing the coordination of transition of members in the community. Works with leadership to ensure the timely and safe transition of members in the community from various levels of health care services including coordinating care plans with community care coordinators, educating transition enrollees about services, requirements, limitations, and / or exclusions of services as a result of the transition. May perform and / or assist with member assessment / screenings; may develop and / or assist with developing member transition plan or service plan / care plan.

Key Responsibilities :

Supports care coordination team, providers, and / or other health care team members to develop an effective transition plan for members in the community and / or into adulthood and adult services / providers, as appropriate

Assists with the transition for members in the community based on enrollment or transition of care for services identified

Works with care coordination and care management team to identify new member enrollees requiring transition services

Ensures existing authorizations are honored during the transition process and works with care management team and providers to address any issues

Acts as an available resource for members and their families and / or caregivers to educate on services, requirements, limitations, and / or exclusions of services as a result of transition planning

May track and maintains transition metrics including new member assessments, volume of members transitioning into or out of care to identify trends and process improvements, and ensures all transition of care information is appropriately documented

Supports with efforts to draft education materials and resources for members on requirements, limitations, or exclusions of services for transition of care

Assists with developing education and training programs for care coordination staff and providers to improve transition services for members

May evaluate the needs of the member, the resources available, and recommends and facilitates the plan for the best outcome

May coordinate as appropriate between the member and / or family / caregivers and the care provider team to ensure members are being effectively treated

Interacts with healthcare providers as appropriate to facilitate member care coordination needs

Performs other duties as assigned

Complies with all policies and standards

Background & Context :

This team supports Medicaid kids program. We work with the star kids program, which is Medicaid kids program. This team specifically works with the population of 15-20 year olds up to their 21st birthday age range. Our purpose is to get them prepared for adulthood and transitioning them to adult Medicaid and adulthood. We talk to them about what it means to become an adult, and we try to help them with education, jobs, etc. These children have disabilities, so we try to assist them with getting jobs, going to college, and become successful adults. We provide resources for housing, utilities, food banks, etc. when needed.

Qualification & Experience :

Education / Experience :

Requires a Bachelor's degree and 2 - 4 years of related experience.

Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

License / Certification :

For Health Net of California LVN / LPN State Licensure required