CareSource · 3 hours ago
Transitions Coordinator-Post Acute
United States
Full-time
Remote
Mid Level
$63K/yr - $100K/yr
3+ years expCareSource is a management services organization that focuses on providing healthcare solutions. The Transitions Coordinator-Post Acute is responsible for managing member level of care transitions and ensuring compliance with regulations while collaborating with various stakeholders to provide appropriate services.
Health CareMedicalNon Profit
Responsibilities
Acts as point of contact with the Care Coordinator, Waiver Service Coordinator, Medical Director, Provider, or other stakeholders to function in a collaborative role as a member of the interdisciplinary care team (ICT) to support coordination of level of care transitions related to long-term and respite nursing facility services and HCBS waiver services
Ensures timely nursing facility-based level of care completion, respite request reviews, and/or HCBS waiver enrollment/disenrollment to maintain compliance with regulatory and accreditation regulations
Verifies eligibility, previous enrollment history, and demographics of members during case reviews
Monitors and assists members to maintain benefit eligibility during level of care transitions
Completes prospective and retrospective review of requests for NF level of care determinations, respite care, and waiver enrollment or disenrollment per established processes
Coordinates, oversees, and provides input in the clinical documentation system for requested services per established processes
Responsible for clinical functions related to level of care transition processes; supports appeals processes as requested
Coordinates with the Care Coordinator, Waiver Service Coordinator, provider, and/or other stakeholders to gather clinical documentation to complete level of care transition processes
Coordinates care with care coordinators, waiver service coordinators, providers, and/or other stakeholders to facilitate NF discharge planning in a timely and cost-effective manner
Reviews current documentation of contacts, treatment plans, case notes, referrals, and assessments in the electronic medical record according to current accreditation and compliance guidelines
Assists with development and implementation of care plans as needed, by defining specific issues, prioritized goals and interventions as agreed to by all parties
Documents, identifies and communicates with Health Partners, Care Coordinators, Waiver Service Coordinators, Medical Directors, Discharge Planners, Providers and/or other stakeholders as needed for care coordination and to establish safe transition plans between levels of care when clinically appropriate
Closely collaborates with care coordinators and waiver service coordinators for any identified changes in eligibility for a member’s assessed level of care and/or with any changes in level of care determinations identified by providers or other external stakeholders
Maintains knowledge of federal and state regulations governing CareSource, State Contracts and Provider Agreements, and CareSource Medicare and Medicaid benefits (including HCBS and nursing facility-based services)
Attends and participates in interdisciplinary team meetings, State Hearings, and/or Medical Advisement meetings, when requested
Escalates identified care coordination needs to the appropriate care coordination and/or waiver service coordination team member(s) and leader(s)
Identifies and refer quality issues to Quality Improvement
Maintains appropriate documentation following protocols and guidelines of the MyCare Program
Precepts and/or mentors new staff
Participates in special projects or research, as requested
Maintains required reporting and assists with data analysis, as requested
Performs other job duties, as requested
Qualification
Required
Completion of an accredited Registered Nurse (RN) degree program or degree required to obtain Social Worker licensure in the state of Ohio is required
Minimum of three (3) years of experience in case management and/or managed care is required
Current, unrestricted Registered Nurse (RN), Licensed Social Worker (LSW), or Licensed Independent Social Worker (LISW) licensure in the state of Ohio is required
Preferred
Bachelor of Science in Nursing (BSN) or equivalent baccalaureate degree in healthcare field is preferred
Experience in a Medicare and/or Medicaid managed care environment is preferred
Post-acute, home care, waiver, or acute clinical care experience is preferred
Multi-state licensure is preferred
Case Management Certification (CCM) is preferred
Benefits
You may qualify for a bonus tied to company and individual performance.
A substantial and comprehensive total rewards package.
Company
CareSource
CareSource provides managed care services to Medicaid beneficiaries.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
FHLB Cincinnati
2026-01-17Grant
Leadership Team
Erhardt Preitauer
President & Chief Executive Officer
Jason Bearden
Market President and CEO, Georgia
Recent News
2026-01-18
Dayton Daily News
2025-12-17
Company data provided by crunchbase