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Resp & Qualifications
PURPOSE: Transition Care Coordinator is assigned to those post-acute care facilities within a specific PCMH Region or to facilities outside of the MD, DC and Northern VA are to oversee the Transitions of Care Program, as follows:
1. Supports the PCMH and other TCCI Programs for both attributed and non- attributed members, ensures the coordination and continuity of health care as Members transfer from the acute care setting to a post- care setting, or home.
2. Provides the critical bridge between acute inpatient care and post-acute settings for Members in need of intensive skilled or rehabilitation services.
3. Transitions Members to the appropriate TCCI Programs, including Attributed and Non-attributed LCCs, Home Based Services or Behavioral Health and Substance Use Disorder Programs to best address ongoing medical and behavioral health needs of the Member.
4. Through the timely and appropriate use of post-acute care, facilitates the Member’s return to pre-illness or pre-injury baseline.
5. Reduces preventable hospital ER visits and/or readmissions by improving care coordination in the post-acute care setting.
Under the general direction of the Director of Post-Acute Transitions of Care, the incumbent’s responsibilities include, but are not limited to, the following:
Rapidly assesses Members for post-acute care coordination needs
Implements an effective Post-Acute Transitions of Care Program for attributed and non-attributed Members.
Communicates and interacts with Members, TCCI Care Coordinators, Physicians, and other providers.
Manages all CareFirst Products
SUPERVISORY RESPONSIBILITY: This position does not have any direct reports. The Transition Care Coordinator oversees the inpatient discharge planning process and coordinates the discharge plan with multiple healthcare professionals.
Requires a bachelor’s degree in Nursing or equivalent experience and must have 7-10 years of increasingly responsible hospital related experience working in Care Management, Discharge Coordination, Home Health, or Disease Management; must possess extensive knowledge of how to manage care delivery guidelines and systems. Proven care management experience is critical.
The incumbent must have excellent analytical and problem-solving skills, excellent organizational, communication and coordination skills. This position requires 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 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. The incumbent must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. The incumbent 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.
A current DC, MD, or VA Registered Nurse License is required.
*Required vaccinations/screenings and training requirements are subject to change based on Departmental policies.
**Assignments are subject to change based on evolving business needs
Thorough knowledge of CareFirst clinical guidelines, medical policies and accreditation and regulatory standards relating to transitional care/case management. Previous work experience within CareFirst Care Management. Working knowledge of CareFirst IT and Medical Management systems.
MSN or CCM, and familiarity with web based software application environment.
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: 5/18/2018
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.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship