Transition of Care Coordinator (Remote NC)

LOCATION: Remote - the is a home-based, virtual position that operates within the hours of 8:30am-5:00pm EST. Applicants may live anywhere in Vaya's catchment area. The person in this position must live in North Carolina or within 40 miles of the NC border.

GENERAL STATEMENT OF JOB

This Transition Care Coordinator (TCC) is responsible for providing oversight and assisting in the process of individuals transitioning to and from health plans (Standard Plans, LME/MCOs, Trible Options) to individuals having a secondary Mental Health, Substance Use or Intellectual Developmental Disability needs. The Transition Care Coordinator works with the transitioning health plan/entity, member and care team to alleviate gaps in care through collaboration, file transfer and review, multidisciplinary team care planning, linkage and/or coordination of services across the MH/SU/IDD and other healthcare network(s) with existing or new care team members. The Transition Care Coordinator may support and provide administrative transition planning assistance to local hospitals and other institutions. This is a mobile position with work done in a variety of locations. The Transition Care Coordinator may work with members in their home communities. The Transition Care Coordinator also works with other Vaya staff, members and family members, and providers as well as community stakeholders. Essential job functions of the Transition Care Coordinator include, but may not be limited to:

• Overseeing the transition of care process
• Liaison with SP PHP's, LME/MCOs and Tribal Options
• Review prior authorizations from the former insurer and ensure that these are honored in the Tailored Plan
• Ensure that Out of Network Agreements are executed timely in order to ensure continuity of care
• Ensure that appropriate Release of information are obtained
• Outreach new members transitioning from another plan
• Maintaining and updating policies and procedures applicable to Transitions of Care
• Innovations transitions
• Responding timely to requests for information from receiving plans
• Ensuring that high acuity members transitioning to another plan have appropriate documentation sent

ESSENTIAL JOB FUNCTIONS

Running and Review Reports:

The Transition Care Coordinator is responsible for overseeing transition activities such as identifying members who are transitioning to and from Vaya Health and identifying the health plans members will be transitioning to and from using reports and data review.

Coordinating Transitions Between Health Plans:

The Transition Care Coordinator will comply with all transition requirements and timeframes for contacting members and transitioning entities as established by policy. The Transition Care Coordinator will assist with coordinating care for members transferring into Vaya Health through a person center approach, establishing continuity of care by confirming current appointments are keep such as physical health, behavioral health, and non-emergent transportation based on reviewing prior authorizations, contact with the member, contact with the care team and contact with the transitioning entity. The Transition Care Coordinator will be responsible for confirming member's prior authorization in the Vaya MCIS system. The Transition Care Coordinator will link the member and care team to appropriate services, providers and community resources based on member's needs. This role requires the development and to maintain collaborative relationships internal and external. The Transition Care Coordinator will function as the liaison for health plans and the Department of Health Human Services to assist with providing and requesting records and relevant documentation for transitioning members to and from Vaya Health to reduce gaps in care.

Reviewing Transitional Documentation:

The Transition Care Coordinator is responsible for assuring transitioning members from Vaya Health has submitted the required document to the transitioning entity within required timeframe. The Transition Care Coordinator is the liaison with the transitioning entity and initiates warm handoff staffing for members that require additional assistance in transfer. The Transition Care Coordinator will review clinical documentation for the member's biological, psychological, and social needs to determine if member meets criteria for warm handoff. The Transition Care Coordinator will be responsible for gathering and assisting in completing transitioning documentation such as the warm handoff summary and or release of information to be submitted with the transition file. The Transition Care Coordinator is responsible for understanding the requirements for complex care management and make referrals when appropriate for members that transition into Vaya Health.

Documentation:

• Maintains administrative health record compliance/quality according to Vaya policy.
• Proactively monitors own documentation to ensure that issues/errors are resolved as quickly as possible.
• Ensures all clinical and non-clinical documentation meet state, agency and Medicaid requirements.

Other duties as assigned.

KNOWLEDGE, SKILLS, & ABILITIES

A demonstrated knowledge of the assessment and treatment of mental illness with or without co-occurring developmental disabilities, is a necessity. Employee will participate in and maintain Care Management and Vaya trainings and proficiencies as required. This position requires exceptional interpersonal skills, highly effective communication ability, and the propensity to make prompt independent decisions based upon relevant facts and established processes. Problem solving, negotiation and conflict resolution skills are essential to balance the needs of both internal and external customers. The employee must be detail oriented, able to independently organize multiple tasks and priorities and to effectively manage and assigned caseload under pressure of deadlines. Knowledge in Vaya Medicaid B and C waivers and accreditation is essential. The employee must be detail oriented, able to organize multiple tasks and priorities, and to effectively manage projects from start to finish. Work activities quickly change according to mandated changes and changing priorities within the department. The employee must be able to change the focus of his/her activities to meet changing priorities. Proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.) and Vaya information system is required.

Training may be delivered in a variety of methods and forums. Transition Care Coordinator must understand the following areas, in addition to other required trainings:

• BH I/DD Tailored Plan eligibility and services
• Whole-person health and unmet resource needs (ACEs, Trauma, cultural humility)
• Community integration (Independent living skills; transition and diversion, supportive housing, employment, etc)
• Components of Health Home Care Management (Health Home overview, working in a multidisciplinary care team, etc)
• Health promotion (Common physical comorbidities, self-management, use of IT, care planning, ongoing coordination)
• Other care management skills (Transitional care management, motivational interviewing, Person-centered needs assessment and care planning, etc)
• Serving members with I/DD or TBI (Understanding various I/DD and TBI diagnoses, HCBS, Accessing assistive technologies, etc)
• Serving children (Child- and family-centered teams, Understanding of the "System of Care" approach)
• Serving pregnant and postpartum women with SUD or with SUD history

In addition, Transition of Care Coordinator must have thorough knowledge of standard office practices, procedures, equipment and techniques and have intermediate to advanced proficiency in Microsoft office products (Word, Excel, Power Point, Outlook, Teams, etc).

EDUCATION & EXPERIENCE REQUIREMENTS

Bachelor's degree in Special Education, Psychology, Social Work or closely related Human Services area is required.

• Two (2) years of post-degree professional experience required.
• Must qualify as a QP for Development Disabilities.

PHYSICAL REQUIREMENTS

• Close visual acuity to perform activities, such as preparation and analysis of documents, viewing a computer terminal, and extensive reading.
• Physical activity in this position includes crouching; reaching; walking; talking; hearing; repetitive motion of hands, wrists, and fingers.
• Sedentary work with lifting requirements up to 10 pounds; and sitting for extended periods of time.

RESIDENCY REQUIREMENTS: The person in this position must reside in North Carolina or withing 40 miles of the North Carolina border.

SALARY: Depending on qualifications & experience of candidate. This position is non-exempt and is eligible for overtime compensation.

DEADLINE FOR APPLICATION: Open until filled

APPLY: Vaya Health accepts online applications in our Career Center. Please visit https://www.vayahealth.com/about/careers/.

Vaya Health is an equal opportunity employer.