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Transition Specialist

2 months ago

Cherry Hill, United States New Hampshire Healthy Families 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.

  • Must reside in NJ
  • 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

Must reside in NJ

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.

Pay Range: $25.97 - $46.68 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 regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.