Resp & Qualifications
PURPOSE: Behavioral Health Hospital Transitions Coordinator (BHTC) is assigned to a specific hospital, region or facility to which they are familiar and oversees the Care Transitions program, as follows:
PRINCIPAL ACCOUNTABILITIES: Under the general direction of the Director, Regional Care Coordination, and with clinical oversight of a Director, Behavioral Health Clinical Oversight, the incumbent’s accountabilities include, but are not limited to, the following:
Rapidly triages members into the appropriate level
s for the Behavior Health Hospital Transition of Care program.
Implements an effective Behavioral Health Care Transitions program for members identified for follow-up
Contacts identified CareFirst members post discharge and actively follow up to verify the transition plan and care connections.
Coordinates necessary interventions.
Communicates with PCMH when members are attributed, to improve the care connections from another level of care. Offers assistance to those members who do not have a primary care practitioner to select a PCP for care coordination and improved outcomes through the CareFirst website.
Primary role as coordinator/facilitator—proactively guiding members to the appropriate CareFirst programs and resources designated as best, to achieve program goals of reduced readmissions, cost-efficiency and quality outcomes.
Ensures the transition of care from one setting to another for identified CareFirst members. Provides member centric interventions such as verifying appointments and coordinating medically necessary home health services.
Proactively identifies, assesses, and coordinates health care services based on the member’s needs and benefits.
Coordinates appropriate referrals for TCCI Programs, such as PCMH, Behavioral Health Care Coordination, Complex Case Management, Disease Management, Addictions Program, Wellness and Medication Reconciliation and communicates with those referral sources to improve transition.
Offers assistance to members and providers for alternative settings of care.
Communicates and interacts professionally with physicians, other providers, and members.
The incumbent must have excellent analytical and problem-solving skills, excellent organizational, communication and coordination skills. The incumbent must have effective presentation, negotiation and influencing skills to interface with all levels of management and physician practices. The incumbent must be able to apply complex problem-solving abilities to achieve problem and process solutions.
The incumbent is required to have had the vaccinations listed below and been appropriately screened (and cleared) for the items listed below. If the incumbent has not had them or been screened and cleared, they must do so upon acceptance of offer:
The incumbent is required to complete the following training as assigned by Management, including, but not limited to:
** Onsite Hospital Assignments are subject to change based on evolving business needs
Must be able to effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads that can be variable for long periods of time. Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Thorough knowledge of Behavioral Health and Substance Use Disorders in a managed care setting including clinical guidelines, medical policies and accreditation and regulatory standards relating to care coordination. Working knowledge of medical and behavioral management computer systems. Knowledge of Microsoft Office programs and web based computer systems.
Department: Hospital Transition of Care
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 7/31/2018
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
Potential Job Hazards:
The position is located within an inpatient hospital facility.
There is the potential for exposure to airborne illnesses, such as, but not limited to, tuberculosis, measles, mumps, rubella, varicella and influenza. The following administrative controls are in place to limit or minimize exposure potential:
There is the potential for exposure to Bloodborne Pathogens if not aware of surroundings at all times. The following administrative controls are in place to limit or minimize exposure potential:
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship