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Regional Transition Coordinator - Northern VA

UnitedHealth Group

Arlington, VA
Job Code:
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Job Details

Regional Transition Coordinator - Northern VA(Job Number:729468)

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work. (sm)
The primary purpose of this position is to effect efficient transitions for Commonwealth Coordinated Care Plus members across the continuum, including transition of members from the nursing facility care to care in the community, and serve as a clinical resource for the Care Coordination Team. The scope of transition services includes assessing not only medical/health needs but also assessing the Member’s social determinants of health (e.g., housing, transportation, social interactions, etc.). and the will development of  an inclusive and realistic transition plan for the member and assist in addressing the components of a transition plan, i.e. assist with finding housing; setting up non-medical transportation; helping the individual integrate into the community through clubs, volunteering/work, faith organizations, etc.
**This role requires 40 - 60% local travel and 10 - 15% statewide travel.**
Primary Responsibilities:
  • Participate in discharge planning for Members transitioning from acute institutional settings to lower levels of care, including Long Stay Hospitals, Nursing Facilities, and the community.
  • Coordinate with the assigned care coordinator in discharge planning activities to ensure a safe transition that meets the Member’s needs and preferences;
  • Coordinate with Utilization Management staff, as indicated regarding discharge planning;
  • Coordinate with Nursing Facility staff, the Member’s assigned care coordinator, and the Member when it is identified that the Member wishes to transition from NF care to the community;
  • Provide support to care coordinators to maintain Members in the community in lieu of transitioning to institutional settings, as needed; and,
  • Utilize and partner with community resources (e.g. CILs, CSBs, AAAs, etc.) and work with staff to facilitate transitions when a member transitions to a lower or less restrictive level of care (e.g., a NF Member wishes to transition to the community, a member in inpatient hospital (medical or psychiatric) transfers to a NF or the community, a CCC Plus Waiver Member no longer meets NF criteria, etc.).
  • Provide consistent follow up during the first year after discharge and shall make adjustments to the transition plan to assure acclimation and integration into the community as needed by the Member.
  • For Dual eligible members enrolled in a DSNP, the Regional Transition Coordinator shall also work with the DSNP care coordinator upon approval of the Member, to coordinate the above activities.
  • Review daily census and prioritizes daily work in accordance with Care Coordination policies
  • Actively collaborate and communicate with physicians and providers to arrange appropriate follow up, discharge planning and/or alternative care and services for plan members
  • Coordinate the authorization process for discharge planning needs in accordance with Plan policy and procedure
  • Coordinate transition of members to other Level Care Coordinators when indicated
  • Perform other delegated duties as assigned

Job Case Management
Primary Location US-VA-Arlington
Other Location US-VA-Leesburg, US-VA-Falls Church, US-VA-Alexandria, US-VA-Woodbridge, US-VA-Reston
Organization C&S New Market Start-Up
Schedule Full-time
Number of Openings 1
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UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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