The Transition Coordinator is responsible for coordinating and supporting activities related to inpatient concurrent review process for both inpatient and post discharge needs.
Essential Duties & Responsibilities
- Demonstrates regular, reliable and predictable attendance.
- Coordinates activities (such as gathering member information to determine future resource needs, obtaining follow-up physician appointments, coordinating follow-up visits with home health agencies, etc.) that support concurrent review while interacting with customers. Acts as liaison between the member, provider, facility, PCP (primary care physician) and Health Net.
- Works to expedite access to obtain follow-up physician care for members with urgent or immediate needs.
- Interacts with providers and facilities to research issues and collect information.
- Administers scripted assessments pertaining to the member's current health status, resource utilization, past and present treatment plan and services.
- Collects data for the coordination of services and cost effective management of health care resources to meet the member's health care needs and promote positive health outcome.
- Documents services delivered to the member to assist the manager and Health Net RMD (Regional Medical Director) in determining if the goals of the plan of care are being met, whether the outcomes are appropriate and realistic, and what actions, if any, may be implemented to enhance positive outcomes.
- Performs other duties as required.
- High school diploma required.
- LVN/LPN diploma from accredited school of Nursing REQUIRED.
- Active, valid, maintained & unrestricted state of AZ LVN/LPN license REQUIRED.
Government Clearance & US Citizenship Requirement
Minimum three years of experience in a physician office, medical group, skilled nursing facility or inpatient setting with a focus on front/back office, case management, social service designee, discharge planningFamiliarity with medical terminology and coding preferredORAny combination of academic education, professional training or work experience, which demonstrates the ability to perform the duties of the position.
Knowledge, Skills & Abilities
- Ability to work independently and as a team player who builds effective working relationships
- Problem-solving skills, proactive thinking and ability to anticipate issues
- Ability to collaborate with clinical staff to address ongoing needs of members
- Ability to understand psychosocial barriers and members' needs
- Good understanding of contracted network/resources for assigned medical group including PCP, specialist physicians, radiology, laboratory services, urgent care, etc.
- Organizational and time management skills
- Verbal and written communication skills
- The following section describes the general physical requirements for this position. Please note that constant refers to more than 81% of time; significant refers to 40-80%; and moderate refers to 20-40% of the time.
- Operates personal computers, printers, facsimile, telephones, copy machines and other commonly used office accessories/equipment.
- Exposed to confidential information and expected to maintain confidentiality at all times; must adhere to HIPAA rules and regulations.
- May be required to work outside of normally scheduled hours as mandated by the client, project and/or workload (e.g. evenings, weekends, and/or holidays)
- May be required to maintain established work pace, meet deadlines; may have last minute urgent requests.
- Physical activity may include: twisting, reaching, kneeling, bending, stooping, squatting, crawling, grasping, grabbing, pushing, pulling, repetitive motion, climbing, etc.
- Required to have visual acuity to determine the accuracy, neatness, and thoroughness of the work assigned.
- Required to have hearing ability to receive detailed information through oral communication
- Required to have speaking ability to express or exchange ideas.
- Constant concentration may be required on various subjects by listening, reading and thinking clearly.
- Interaction with others may be required. May need to listen, think, and speak in order to interact with others. Business interactions and behavior between coworkers and/or external customers are required. This may require face-to-face or telephone interactions.
- Thinking at work may include listening, learning, analyzing, evaluating, and the ability to interpret what is seen and/or heard, or to link information from one issue to the next.
- Significant computer usage including typing and/or eye strain.
- Significant repetitive arm, wrist, hand and finger motions -- making repetitive movements (e.g. key boarding, filing, data entry).
- Significant phone usage; headsets may be required.
- Moderate amount of time spent working in a loud office environment with frequent interruptions/distractions.
- Constant sedentary work (desk bound or seated).
- Constant reading is required via computer screen and/or bound printed materials.
DISCLAIMER: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this job. They are not intended to be construed as an exhaustive list of responsibilities, duties and skills required of personnel so classified.
Health Net, Inc. supports a drug-free work environment and requires pre-employment background and drug screening.
Health Net and its subsidiaries are an Equal Opportunity/Affirmative Action Employer - Minorities/Females/Veterans/Disability
About Health Net, Inc.
Health Net, Inc. (Health Net) is an integrated managed care organization that delivers managed healthcare services through health plans and government-sponsored, managed-care plans. The Company operates and conducts its businesses through its subsidiaries. Health Net's health plans and government contracts subsidiaries provide health benefits through its health maintenance organizations (HMOs), insured preferred provider organizations (PPOs) and point-of-service (POS) plans to approximately 6.7 million individuals across the country through group, individual, Medicare, (including the Medicare prescription drug benefit commonly referred to as Part D), Medicaid, TRICARE and Veterans Affairs programs. The Company operates within two segments: Health Plan Services and Government Contracts.