Senior Transition Specialist at Fidelis Care - New Jersey

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.

* Applicants for this job have the flexibility to work remote from home in Central or Southern New Jersey.

Position Purpose: Provides expertise based on experience with identifying, overseeing, and managing the coordination of transition of members in the community. Works with leadership to address complex issues and ensures the timely and safe transition of members in the community from various levels of health care services including coordinating care plans with community care coordinators, educating transition enrollees about services, requirements, limitations, and/or exclusions of services as a result of the transition. May perform and/or assist with member assessment/screenings; may develop and/or assist with developing member transition plan or service plan/care plan.

• Works with care coordination team, providers, and/or other health care team members to develop an effective transition plan for members in the community
• Assists with the transition of care 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 review 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
• Partners with leadership to identify process improvements for transition of care for members and provides recommendations
• Assists with developing 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 of care 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

Education/Experience: Requires a Bachelor's degree and 4 – 6 years of related experience or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act