Transfer of Care Coordinator - KS MCD

Overland Park, KS
United States

Job Description
The Transfer of Care Coordinator is dedicated to the KanCare contract with demonstrated expertise in facilitating and coordinating care transitions across the continuum of care settings and throughout the Members lifespan. This position is responsible for working across internal business units and directly coordinating with care coordination staff, external community entities and participating providers to provide advice and support for complex transition of care cases. Works closely with functional area managers to ensure consistency in clinical interventions supporting our members. Accountable for meeting the financial, operational and quality objectives of the unit. Supports the business by recommending appropriate actions, strategies and/or alternatives to meet business needs. Has responsibility for leading/managing program such as planning, coordination, development, implementation including the financial implications while prioritizing work, resources and time. Highly collaborative process often requires managing relationships across the multiple functional areas.

Frequent field based travel with personal vehicle is required; must have dependable transportation, valid and active KS driver's license and proof of vehicle insurance.

Fundamental Components:
- Oversees the implementation of healthcare management services for assigned functional area.
- Implements policies & procedures in accordance with applicable regulatory and accreditation standards (e.g. NCQA, URAC, state and federal standards and mandates as applicable).
- Serves as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking.
- Ensures implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care.
- Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
- Develops and implements strategic business plan to achieve business goals.
- Proactively leads project by setting strategic direction.
- Identifies gaps and recommends enhancements related to new and/or existing products, services and workflows based on broadview of the organization.
- Collaborates and partners with other functional managers, other business areas across/within segments or other business areas to ensure all workflow processes and interdependencies are identified and addressed.
- Consults with constituents (these may be internal and/or external) to scope/define project.
- Influences change in order to improve performance results, organization effectiveness and/or systems/quality/services.
- Obtains financial support for projects or supports the work as it relates to program management.
- Collaboratively works across multiple functions and/or segments to obtain agreement from all impacted parties (e.g., up and downstream effects often impact multiple functions and/or segments.
- Responsible for development and implementation of new ideas that supports work/team.
- Cross-function/segment group facilitation/presentation.
- Accountable for maintaining compliance with policies and procedures and implementing them at the employee level.
- May act as a single point of contact for the customer and the Account Team including: participation in customer meetings, implementation and oversight of customer cultural requirements, and supporting implementation of new customers.

Qualification Requirements:
- Minimum of 3-5 years relevant work experience is required.
- Ability to communicate effectively with Providers, Members, staff and other leaders both in verbal, written and presentation formats required.
- Experience working with diverse teams and populations required.
- Knowledge of community resources and provider networks required.
- Ability to evaluate and interpret data, identify areas of improvement, and focus on interventions to improve outcomes required..
- Computer literacy and advanced proficiency with Microsoft Excel, Word, and web-based applications and access databases is required.
- Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment required.
- I/DD (Intellectual or Developmental Disability) experience strongly preferred.
- LTSS and BH experience strongly preferred.
- MCO experience preferred.

Bachelor's degree or equivalent work experience required (BSN preferred).

Licenses and Certifications:
- Registered Nurse (RN) for State of KS is preferred.
- Mental Health/Licensed Independent Social Worker for State of KS is preferred (e.g., LSCSW, LCPC, LCP, LCMFT, LCAC)

General Business/Demonstrating Business and Industry Acumen/ADVANCED
General Business/Ensuring Project Discipline/MASTERY
Leadership/Fostering a Global Perspective/FOUNDATION

General Business/Applying Reasoned Judgment/MASTERY
Leadership/Creating Accountability/ADVANCED
Service/Demonstrating Service Discipline/ADVANCED

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

Benefit eligibility may vary by position.

Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.