Transition Care Coordinator is responsible for telephonically and/or face to face assessing, planning, implementing and coordinating transition activities with members and their primary case manager, as well as other Aetna staff, including community health workers, peer support worker, housing specialist, and work force specialist to evaluate the medical and social needs of the member to facilitate the member’s successful transition between settings/levels of care. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes of the transition. Coordinates/communicates with providers/institutions to coordinate successful and safe member transitions to/from community or other institutions. Also works to track and report on transition work, as well as other state contractual requirements.
Schedule is Monday-Friday standard business hours. NO NIGHTS, NO WEEKENDS AND NO HOLIDAYS!
Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs/plans and alternate settings as necessary. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues. Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Using a holistic approach assess the need for a referral to clinical and community resources for assistance in safe integration into alternate setting. Consults with supervisor, primary case manager, and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences with primary case manager for multidisciplinary focus to benefit overall claim management and ensure member needs are being met. Frequent communication with providers such as hospital discharge planners and nursing facility social workers to coordinate member care transitions and meet member needs. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation. Must also manage and coordinate trainings within region on transition processes, including processes changes communicated by DMAS. Frequent work with spreadsheets and data tracking and reconciliation.
preferred 5 years clinical practice experience
Case management and/or discharge planning experience required.
Must be proficient with basic excel functions (no pivot tables or formulas required).
RN with current unrestricted Virginia state licensure required.
Additional Job Information:
Typical office working environment with productivity and quality expectations. Travel to meetings with members, coworkers, and provider staff required within the region. Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment. Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding, as well as use of excel. Effective communication skills, both verbal and written. Requires driving to provider/member meetings as needed for transition planning and coordination.
General Business - Applying Reasoned Judgment, General Business - Communicating for Impact, General Business - Consulting for Solutions, General Business - Maximizing Work Practices
General Business - Demonstrating Business and Industry Acumen, General Business - Turning Data into Information, Leadership - Anticipating and Innovating, Leadership - Collaborating for Results
Clinical / Medical - Direct patient care (hospital, private practice), Clinical / Medical - Disease management, Nursing - Case Management
Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel
Nursing - Registered Nurse (RN)
Potential Telework Position:
Percent of Travel Required:
25 - 50%
Aetna is an Equal Opportunity, Affirmative Action Employer
Benefit eligibility may vary by position.
Candidate Privacy Information:
Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.