Transition Specialist - Tyler - The Health Plan

 
Position: Transition Specialist - Tyler - The Health Plan

Job ID: 155780

Location: US-TX-Tyler

Department: TRANSITION SPECIALIST

Talent Area: Administrative Support

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 8a - 5p

About Texas Children's Hospital

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.   To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

Summary:

We are searching for a Transition Specialist -- someone who works well in a fast-paced setting. In this position, you will be responsible for deployment of transition and development of a transition plan for Members aged 15 years and above. Coordination includes securing adult care provider relationships found satisfactory to the Member/LAR. Adolescent transition support for adolescents with special healthcare needs requires developing and maintaining positive relationships with Members and their families, and care providers for both pediatric and adult populations. This position interacts with Members, caregivers, specialists and primary care providers as well as ancillary providers and service coordination team on a daily basis. This position is also responsible for assessments, coordination activities, referral and linkage to community resources, monitoring and tracking outcomes.

 

Think you’ve got what it takes?



Responsibilities :

  • Develops and maintains satisfactory business relationships with participating providers in adult and pediatric networks
  • Reviews and interprets all relevant information with Member/family and develops/initiates a transition plan and self-management plan with family telephonically
  • Develops a continuity of care plan for transitioning Medicaid services and benefits from STAR Kids to the STAR Plus Medicaid managed care model without a break in service with the Member/LAR as a prime resource and the care team as approval agents
  • Telephonically communicates to Member for periodic evaluation and assessment of unmet functional needs, educational needs and goal attainment seeking Member/LAR input in transition plan
  • Travels to Member homes for periodic evaluation and assessment of unmet functional needs, educational needs and goal attainment seeking Member/LAR input in transition plan
  • Ensures thorough communication and education to Members/providers an understanding of delivery system capabilities to improve access and address Member needs
  • Coordinates with DARS and local resources for the identification and support of employment and training opportunities for Members


Qualifications:

  • High school diploma or GED required
  • Community Health Worker certification preferred
  • 3 years’ experience in health care required
  • Experience in health care, local and state programs for children with disabilities or managed care setting preferred
  • Bilingual is preferred


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