Full-Time

Transition Specialist

Posted on 1/16/2025

Centene

Centene

10,001+ employees

Provides health insurance and services

Healthcare

Compensation Overview

$26.5 - $47.59Hourly

Mid

Remote in USA

Category
Healthcare Administration & Support
Medical, Clinical & Veterinary

You match the following Centene's candidate preferences

Employers are more likely to interview you if you match these preferences:

Degree
Experience
Requirements
  • Requires a Bachelor's degree
  • 2 – 4 years of related experience
  • Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
Responsibilities
  • Provides support with identifying, overseeing, and managing the coordination of transition of members in the community.
  • Works with leadership to ensure the timely and safe transition of members in the community from various levels of health care services including coordinating care plans with community care coordinators.
  • Educates transition enrollees about services, requirements, limitations, and/or exclusions of services as a result of the transition.
  • May perform and/or assist with member assessment/screenings; may develop and/or assist with developing member transition plan or service plan/care plan.
  • Supports care coordination team, providers, and/or other health care team members to develop an effective transition plan for members in the community and/or into adulthood and adult services/providers, as appropriate.
  • Assists with the transition for members in the community based on enrollment or transition of care for services identified.
  • Works with care coordination and care management team to identify new member enrollees requiring transition services.
  • Ensures existing authorizations are honored during the transition process and works with care management team and providers to address any issues.
  • Acts as an available resource for members and their families and/or caregivers to educate on services, requirements, limitations, and/or exclusions of services as a result of transition planning.
  • May track and maintains transition metrics including new member assessments, volume of members transitioning into or out of care to identify trends and process improvements, and ensures all transition of care information is appropriately documented.
  • Supports with efforts to draft education materials and resources for members on requirements, limitations, or exclusions of services for transition of care.
  • Assists with developing education and training programs for care coordination staff and providers to improve transition services for members.
  • May evaluate the needs of the member, the resources available, and recommends and facilitates the plan for the best outcome.
  • May coordinate as appropriate between the member and/or family/caregivers and the care provider team to ensure members are being effectively treated.
  • Interacts with healthcare providers as appropriate to facilitate member care coordination needs.
  • Performs other duties as assigned.
  • Complies with all policies and standards.

Centene Corporation operates in the healthcare industry, focusing on improving the health of underinsured and uninsured individuals. The company provides a variety of health insurance products and services, including medical, dental, vision, behavioral health, and pharmacy benefits. Centene's approach is localized, allowing it to tailor its services to meet the specific needs of different communities across the United States. This model helps the company serve a diverse clientele, with 27.5 million members and significant revenue from premium services. Unlike many competitors, Centene emphasizes cost-effective care while also addressing social barriers to health and promoting sustainability. The company's goal is to enhance health outcomes for its members while ensuring responsible corporate governance and supporting employee well-being.

Company Stage

IPO

Total Funding

N/A

Headquarters

Saint-Louis, Senegal

Founded

1984

Simplify Jobs

Simplify's Take

What believers are saying

  • Expansion of telehealth services enhances access for underserved populations.
  • ICHRA introduction attracts customers seeking personalized, flexible insurance options.
  • Essential Plan expansion highlights growth potential in low-cost insurance markets.

What critics are saying

  • Increased competition in the Health Insurance Marketplace may impact Centene's market share.
  • Potential regulatory changes in Medicaid and Medicare could affect revenue streams.
  • Economic downturns may decrease premium collections, impacting financial performance.

What makes Centene unique

  • Centene's localized approach tailors healthcare services to specific community needs.
  • The company offers a wide range of health insurance products through local brands.
  • Centene focuses on cost-effective, high-quality care for underinsured and uninsured individuals.

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Benefits

Health Insurance

401(k) Retirement Plan

401(k) Company Match

Paid Vacation

Hybrid Work Options

Flexible Work Hours

INACTIVE