This position is a remote position, however, candidates must reside in Hawaii.

This position is responsible for development and implementation of transitional care support for members in inpatient or residential settings stratified as low complexity care management needs in Medicaid, Medicare, and Whole Health markets. Supports members enrolled in Care Management while in a higher level of care facility, along with facilitating member engagement with their primary care and other sources of behavioral health and services support. Maintains their own caseloads and meet standards of care and performance standards as established by the Member Market Leads and Care Management Center of Operational Excellence Lead.

• Manages 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.
• Manages 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.
• Manages 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.
• Maintains current knowledge or researches the availability of community resources and services and links members to appropriate services.
• Provides 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.
• Assists in discharge planning for hospitalized patients and supports appropriate placements as needed.
• Works with the treatment team and assists in coordinating physical, psychological and/or psychiatric services for the member.
• Works 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.
• Assumes responsibility for self-development and career progression.
• Seeks and participates in ongoing training (formal and informal) in all aspects of the Transitions of Care Specialist role.
• Remains responsible for updating self on ever changing information to ensure accuracy when dealing with members.
• Coordinates and manages distribution of correspondence and materials to members and providers.
• Demonstrates 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.

WORK EXPERIENCE - REQUIRED

Clinical

EDUCATION - REQUIRED

A Combination of Education and Work Experience May Be Considered., Associate - Nursing, Bachelor’s - Social Work

RESPONSIBILITIES

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.

This position is responsible for development and implementation of transitional care support for members in inpatient or residential settings stratified as low complexity care management needs in Medicaid, Medicare, and Whole Health markets. Supports members enrolled in Care Management while in a higher level of care facility, along with facilitating member engagement with their primary care and other sources of behavioral health and services support. Maintains their own caseloads and meet standards of care and performance standards as established by the Member Market Leads and Care Management Center of Operational Excellence Lead.

• Manages 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.
• Manages 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.
• Manages 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.
• Maintains current knowledge or researches the availability of community resources and services and links members to appropriate services.
• Provides 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.
• Assists in discharge planning for hospitalized patients and supports appropriate placements as needed.
• Works with the treatment team and assists in coordinating physical, psychological and/or psychiatric services for the member.
• Works 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.
• Assumes responsibility for self-development and career progression.
• Seeks and participates in ongoing training (formal and informal) in all aspects of the Transitions of Care Specialist role.
• Remains responsible for updating self on ever changing information to ensure accuracy when dealing with members.
• Coordinates and manages distribution of correspondence and materials to members and providers.
• Demonstrates 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