Transition Coordinator

Centene

Job Details

Location: Charlotte, Mecklenburg County, North Carolina, USA Posted: Nov 10, 2019

Job Description

Position Purpose: Ensure the timely and safe transition of members into or out of the health plan. Assist in the transition of members back into the community from various levels of health care services.

Manage the transition of care for members enrolling or exiting the health plan

Identify new enrollee requiring transition of care services

Complete assessment of the new Enrollee’s health care needs

Determine the presence of active care needs or possible outstanding service authorizations

Identify the Enrollee’s previous MCO (if applicable)

Contact the previous MCO and/or Primary Care Provider (PCP) to obtain relevant Enrollee information (if applicable)

Ensure existing authorizations with previous health plan or in fee-for-service are honored during the transition, for a minimum of 60 calendar days from the date of enrollment in the health plan

Assist the enrollee with continuing authorization of medically necessary services, transitions into Integrated Care Program, transitions between MCOs, and transitions to private insurance or no coverage.

Coordinate care plans with community care coordinators and the enrollee

Educate transitioning enrollees about services, requirements, limitations and/or exclusions of services as a result of the transition.

About Centene

Centene is a multi-line health care enterprise offering Medicaid managed care and specialty services.

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