Transition Specialist

3 days ago

Brisbane, Queensland, Australia Centene Corporation Full time

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.

NOTE: This hybrid remote role with 75% travel helps members transition from facilities into community settings with home and community based services (HCBS). Preference will be given to applicants who (1) reside in one of the following Pennsylvania counties near the city of Harrisburg: Cumberland, Dauphin, Lancaster, Lebanon, Perry, or York (2) with professional experience in the following areas: service coordination, case management, transition of care, waiver or Pennsylvania Independent Enrollment Broker (PA IEB).

Position Purpose: 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.

  • 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 maintain 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.

Education/Experience: Requires a Bachelor's degree and 2 – 4 years of related experience.

Additional Details:

• Department: Care Management

• Caseload: Facility based members seeking to transition into a community based setting

• Territory: Dauphin County Pennsylvania and surrounding counties

• Schedule: 8-4:30 pm ET with 1/2hr lunch or 8-5 pm ET with 1 hr lunch.

Pay Range: $26.50 - $47.59 per hour

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without

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