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Position Purpose\\: The Transition Nurse is responsible for identifying, overseeing and managing coordination for health plan members during changes or transitions between contracted programs and providers within an assigned region. Manages plan change transition activities including Identifying members with special health care needs requiring transition and coordinate all activities required to successfully transition the member to or from Health Net Ensures that transition activities are accomplished in accordance with applicable health plan/program contractor policies and procedures Acts as an advocate for members leaving and joining the health plan/program Interacts with personnel at all levels with external health plan and program contractors to facilitate communication between impacted parties, including health plan/program contractors and federal programs Assists PCPs, internal health plan/program departments, and other contracted providers with the coordination of care for transitioning members Ensures that continuity and quality of care for transitioning members is maintained during health plan/program contractor transitions Participates in transition planning meetings Makes recommendation to management in regards to developing transition policy Assists with translation of contract requirements into recommendations for internal policies and procedures
Performs other duties as required.
Education/Experience\\: Graduate of an accredited nursing program. Bachelor s Degree Preferred. Minimum three years clinical experience. Minimum five years managed care experience, including Case Management, Utilization Management, and/or Discharge planning. Experience working in a Managed Care Health Plan environment including Medicare / Medicaid. Experience with development of policies and procedures. License/Certification\\: Current, valid and unrestricted RN Licensure Required. Certified Case Manager preferred.Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.