Care Transition Specialist

1 week ago

Honolulu, Hawaii, United States Magellan Health Services Full time
Job Summary

This role is responsible for developing and implementing transitional care support for members in inpatient or residential settings with low complexity care management needs in Medicaid, Medicare, and Whole Health markets.

Key Responsibilities
  • Manage Transitions of Care (TOC) protocols for members in the inpatient or residential setting needing transitions in care support to lower level of care facilities or home, in accordance with workflows and KPIs developed by the CM CoOE Lead.
  • Manage TOC activities including post-discharge follow up appointment scheduling and kept appointments, member specific plans to ensure medication refills and/or MAT participation and successful connection between PH and BH providers.
  • Manage case load of lower complexity level of care members to ensure appropriate services and care management activities are conducted to meet the individual member's needs.
  • Maintain current knowledge or researches the availability of community resources and services and links members to appropriate services.
  • Provide information to members regarding mental health, physical health and/or substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures.
  • Assist in discharge planning for hospitalized patients and supports appropriate placements as needed.
  • Work with the treatment team and assists in coordinating physical, psychological and/or psychiatric services for the member.
  • Work collaboratively with other engagement specialists, care managers, care supports, and other clinical operations team staff to ensure comprehensive and coordinated delivery of services for members.
  • Assume responsibility for self-development and career progression.
  • Seek and participate in ongoing training (formal and informal) in all aspects of the Transitions of Care Specialist role.
  • Remain responsible for updating self on ever changing information to ensure accuracy when dealing with members.
  • Coordinate and manage distribution of correspondence and materials to members and providers.
  • Demonstrate flexibility in areas such as job duties and schedule in order to aid in better serving members and help the company achieve its business and operational goals.
Requirements
  • 2 years' prior work experience in psychiatric or substance use behavioral health setting specific to discharge planning.
  • Ability to independently manage case load of low complexity care management members.
  • Applicable experience related to one of targeted member markets, including Medicare, Medicaid and Whole Health.
  • Ability to plan and implement solutions that directly influence quality of care.
  • Understanding of plan benefit structures, psychiatric/medical terminology, call center terminology and operations.
  • Strong written and verbal communication skills.
About Magellan Health Services

Magellan Health Services is a leading healthcare company that provides innovative solutions to improve the quality and affordability of healthcare. We are committed to delivering exceptional service and support to our members, providers, and partners.

We offer a comprehensive benefits package, including medical, dental, and vision coverage, as well as a 401(k) plan and employee assistance program.

Magellan Health Services is an equal opportunity employer and welcomes applications from diverse candidates.

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