Transition Care Manager

Role Overview: The Transition Care Manager is responsible for completing preventive, multidisciplinary discharge planning for plan members presenting to the Emergency Room and/or Acute Setting, in accordance with AmeriHealth Caritas policies and procedures. The Transition Care Manager will assess and process discharge planning needs across all disciplines, including necessary case management referrals.

Work Arrangement:

• Remote - Associate must reside in the state of Louisiana (LA).
• Associates must have access to a reliable high-speed internet connection to support daily responsibilities, with a minimum download speed of 50 Mbps and an upload speed of 5 Mbps.
• Fully remote associates residing in states where internet service is required by contract, law, or regulation may be eligible for reimbursement.

Responsibilities:

• Consistent application of medical health benefit policy and medical management guidelines to authorize services.
• Appropriately identifies and refers requests to the Medical Director when guidelines are not met.
• Review daily Emergency Room (ER) or inpatient census of plan members.
• Receive and process facility referrals.
• Complete surveys to identify plan member needs.
• Identify gaps in care.
• Determine members' understanding of illness and outpatient management of illness.
• Evaluate, coordinate, and implement discharge needs for all short-term and long-term Behavioral Health needs.
• Refer members for case management and/or social work services based on community needs and resource availability.
• Schedule appointments and arrange critical follow-up calls for care coordination.
• Educate members on how and where to seek appropriate care and follow-up services.

Education & Experience

• Master's degree required.
• Must be a Licensed Mental Health Practitioner.
• Current and unrestricted Licensed Professional Counselor (LPC) or Licensed Clinical Social Worker (LCSW) licensure to practice in the state of Louisiana is required.
• 3 or more years of Behavioral Health experience required.
• 3 or more years of overall healthcare/discharge planning experience required.
• Emergency Room or Acute Discharge Planning experience preferred.

Licensure:

• Must be a Licensed Mental Health Practitioner.
• Current and unrestricted Licensed Professional Counselor (LPC) or Licensed Clinical Social Worker (LCSW) licensure to practice in the state of Louisiana is required.
• Eligibility to obtain Certified Case Manager (CCM) certification within one year of hire
• Valid driver's license and current automobile insurance are required.

Skills & Abilities:

• Proficiency with Microsoft Office Suite, including Word, Excel, Outlook, Teams, and SharePoint in a Windows-based environment.
• Proficiency with electronic medical record and charting programs
• Strong discharge planning, care coordination, and case management referral skills.
• Ability to identify gaps in care and assess member needs across multiple disciplines.
• Knowledge of Behavioral Health discharge planning and community resource coordination.