Transition Specialist

Transition Specialist

Requirements

• Requires a Bachelor’s degree
• 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.

Responsibilities

• 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.
• 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.

Preferred Qualifications

No preferred qualifications provided.