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Health Services WellCare - Case Management Careers

Transitional Care Manager Job

Full Job Title: Transitional Care Manager

Job Number: 1805631

Location: Tampa, FL

Date Posted: 2018-08-07

Works in collaboration with a member's primary care manager to ensure safe and appropriate transitions between levels of care, including working as a part of the interdisciplinary care team in the development and execution of a person-centered transition plan. Coordinates all support staff needed, (e.g., Housing Coordinators, DME Specialists, etc.) and services required are in place for a safe transition. Collaborates with family/caregivers to identify and ensure caregiver needs are met. Establishes and maintains best practices that reflect regional variations in service delivery, including establishing relationships with key facilities, providers, and home and community based (HCBS) resources to assist in transitions. Proactively identifies members residing in nursing facilities or other institutions who are candidates for transitioning back to the community. Assists in reviewing and analyzing data related to rebalancing and developing action plans to meet rebalancing goals.

Reports to: Director Field Care Management

Department: LT-Care

Location: Tampa, FL

Essential Functions:

  • Conducts research, including reviewing reports, medical records, service authorizations, claims history, case notes, caregiver needs etc., to determine member needs for safe transitions to the community.
  • When indicated, conducts telephonic outreach to members, providers and community organizations to support Case Management and/or Quality Improvement, regulatory and contractual metrics and requirements related to community transitions.
  • Maintains accurate records of activities in the care management platform.
  • Maintains HIPAA standards and ensures confidentiality of protected health information. Reports critical incidents and information regarding quality of care issues.
  • Serves as a liaison in corresponding and communicating with providers, vendors and other identified stakeholders to influence rebalancing metrics.
  • Positively collaborates with field health services staff as a part of the interdisciplinary care team to lead transition activities in conjunction with the primary care manager.
  • Ensures compliance with all state and federal regulations and guidelines.
  • Acts as subject matter expert in regards to regional best practices that support successful community transitions.
  • Identifies strategic community providers and stakeholders and establishes positive partnerships and innovative approaches to create/expand community capacity to positively influence rebalancing.
  • Analyzes data to proactively identify areas of opportunity for rebalancing and develops action plans to meet goals.
  • Represents the department / leadership in assigned meetings, special projects, and/or community-facing events.
  • Performs other duties as assigned.
Additional Responsibilities:
    Candidate Education:
    • Required A Bachelor's Degree in a related field
    • Required or equivalent work experience 3 years direct work experience
    • Preferred Other RN, LPN, or Licensed Social Worker
    Candidate Experience:
    • Required 3 years of experience in working with nursing facility eligible individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role
    Candidate Skills:
    • Advanced Ability to effectively present information and respond to questions from families, members, and providers
    • Intermediate Ability to effectively present information and respond to questions from peers and management
    • Intermediate Demonstrated time management and priority setting skills
    • Advanced Demonstrated interpersonal/verbal communication skills
    • Intermediate Knowledge of community, state and federal laws and resources
    • Intermediate Ability to multi-task
    • Intermediate Ability to influence internal and external constituents
    • Intermediate Knowledge of healthcare delivery
    • Intermediate Ability to identify basic problems and procedural irregularities, collect data, establish facts, and draw valid conclusions
    • Intermediate Demonstrated problem solving skills
    • Intermediate Demonstrated customer service skills
    Licenses and Certifications:
    A license in one of the following is required:
      Technical Skills:
      • Required Intermediate Healthcare Management Systems (Generic)
      • Required Intermediate Microsoft Outlook
      • Required Intermediate Microsoft Excel
      • Required Intermediate Microsoft Word
      • Preferred Intermediate Other Knowledge of data entry, documentation and report generation in any clinical system
      • Preferred Spanish

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      Last Updated On: 12/9/2015