TRANSITIONAL CARE CLINICIAN/CARE MANAGER (CA License Clinician Required) in Cypress, CA at Beacon Health Options

Date Posted: 7/30/2018

Job Snapshot

Job Description


We are currently seeking a dynamic Transition Care Clinician to join our team at our office in Cypress, CA.  The Transition Care Clinician is responsible for ensuring that member safely and effectively transition to and from acute setting is handled in a person centered manner and includes comprehensive discharge and transition plans designed to support the member’s return to the community.  The Transition Care Clinician is responsible for coordinating care for members to improve quality and delivery of integrated care for members as they transition across settings. Transitional Care Clinician will have a good understanding of HEDIS measures, NCQA and CMS standards and requirements.

 Position Responsibilities:

  • Monitors inpatient census to ensure that all members who present for inpatient level of care are assigned to a care manager and to Beacon for primary case ownership.

  • Conducts a hospital site visit to complete face to face visit with members, in collaboration with engagement center staff, to engage member in care management services; obtains all necessary Release of Information for coordination of care and provides coaching on importance of aftercare follow-up.

  • Collaborates with Facility Discharge Planners, CHIPA UM, Beacon CM and Aftercare teams on HEDIS-FUH improvement activities

  • Is flexible with schedule to cover late shift hours (5pm-8pm) when needed to complete member aftercare coaching call.

  • Coordination of all discharge planning activities in collaboration with facility discharge planner and social work staff, CHIPA Utilization Management and Beacon Care Management and Aftercare staff for members who are admitted to inpatient facilities.

  • Participation in on-site discharge planning meetings at the facility, when appropriate and necessary.

  • Identification of members with repeat admissions and strategize with care management and UM staff on interventions to improve discharge planning to increase member tenure in the community upon discharge.

  • Ensuring that members discharged from inpatient mental health has an aftercare appointment within 7 days of discharge with a BH provider.

  • Assessing and addressing barriers to a member’s compliance with discharge plan while hospitalized.

  • Follow members for 30-days post discharge to ensure appropriate access to services, identify barriers to treatment adherence, and generally work to improve community tenure post discharge from an acute health episode by coordinating with case management/engagement center staff.

  • During face to face visit with members promote self- management skills while encouraging member empowerment.

  • Responsible for transition of care planning, serving as the point of contact, in collaboration with the Care Manager, for distribution of treatment plan to community based service providers post discharge and ensures that member was provided a copy of the treatment and discharge plan as well.

  • Documents all aftercare and transition information in member record.

  • Securing discharge and transition plans from discharging facilities and evaluating plans to ensure compliance with clinical and quality requirements.

  • Help coordinate member's transition to skilled nursing facility from an inpatient BH unit including assisting with locating and securing an open bed.

  • Identifying community resources and services to improve program effectiveness and quality.

  • Providing individualized person-centered support to members.

  • Serve as adjunct member of member’s Integrated Care Team (ICT) to ensure CM team members are aware of transition so that member’s care plan can be updated accordingly.

  • Coordinates with engagement team and case management team for member needs such as access to multilingual capabilities, access through TTY or TDD for those who are hearing impaired, assistance with locating non-emergency transportation services for members with limited ambulation and information on available services within the community such as food pantries and other public assistance programs.

  • Establish relationship with facilities/providers to coordinate care for members.

  • Responsible for completing work in a timely manner.

  • Meet compliance requirements for state regulatory bodies, CMS, NCQA, Beacon and Health Plan (if applicable) standards.

  • Adheres to all Beacon policies and procedures and standards of operations.

  • Completes all required and assigned trainings in a timely manner.

  • Attends all mandatory company and/or department meetings.

  • Reports to each scheduled shift and commence work and perform essential job function at the start of each schedule shift.

  • Displays a positive, constructive, and helpful demeanor that is conducive to a safe and respectful work environment.

  • Acts as a mentor to junior team members by leading by example and guiding with a sense of integrity and team work.

  • Assists management with identifying opportunities for staff improvement, high performing team members, and training needs of team members.

  • Assist team members and offers suggestions to improve processes, culture, or work environment.

  • Performs special projects and other duties as assigned and required.

 Position Requirements:

Education: Bachelor's degree in nursing, social work or equivalent directly related experience required, Master’s degree preferred.

Licensure:  Valid state clinical license.  Licensed clinician who has the credentials to practice independently, MFT, LCSW, or RN degree in a related health care field.

Relevant Work Experience:   Minimum of two (2) years of direct behavioral health clinical and managed care experience

Knowledge, Skills & Abilities:

  • At least 2 years’ experience in behavioral health required.

  • At least 2 years’ work experience in a behavioral health hospital

  • Experience working with individuals of different cultural and ethnic backgrounds preferred. Bilingual bicultural experience is highly desirable.

  • Managed care experience desired, but not required.

  • Familiar with Clinical Terminology.

  • Excellent prioritization and organization skills

  • Strong interpersonal skills and good written and verbal communication skills

  • Advanced level of PC skills required


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Beacon Health Strategies, LLC., a Beacon Health Options company, is proud to be an Equal Opportunity Employer as well as a Drug Free Work Environment. EOE/M/F/Veterans/Disabled