Transition Specialist

Join Centene as a Remote Transition Specialist supporting our ED Transitions of Care (TOC) team in Wisconsin. The ideal candidate will have a background in healthcare and/or behavioral health, along with familiarity with Wisconsin Medicaid. In this role, you will manage a high volume of inbound and outbound calls, complete assessments, and develop individualized care plans to help members successfully navigate transitions in care.

• 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

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