Transition Specialist

BC Forward is looking for Transition Specialist - Remote

Job Title : Transition Specialist

Location : Remote (Must reside in Indiana)
Duration : 07 months with potential for contact extension

Pay Rate: $19.50 per hour

Position Purpose:
The Transition Specialist supports the identification, coordination, and management of community member transitions across healthcare services. This role works closely with leadership, care coordination teams, and providers to ensure members experience safe, timely, and seamless transitions, whether moving between healthcare levels or entering adult services. The position involves educating members about services, requirements, limitations, and exclusions, assisting with assessments, and contributing to the development of transition or care plans.

Education & Experience:

• Required: Bachelor's degree and 2-4 years of relevant experience
• Equivalent experience demonstrating applicable knowledge, duties, and skills may be considered

Key Responsibilities:

• Support care coordination teams, providers, and other healthcare professionals in developing effective transition plans
• Assist members in transitioning based on enrollment or care service requirements
• Identify new member enrollees needing transition services and coordinate with care management teams
• Ensure continuity of authorizations during transitions and resolve related issues with providers and care management
• Serve as a resource to members, families, and caregivers, educating them on services, limitations, and exclusions
• Track and maintain transition metrics, including new member assessments and volumes, to identify trends and process improvements
• Document all transition of care information accurately
• Assist in drafting education materials and resources for members regarding service requirements and limitations
• Contribute to the development of training programs for care coordination staff and providers to improve transition services
• Evaluate member needs and available resources, recommending and facilitating plans for optimal outcomes
• Coordinate as needed between members/families/caregivers and care provider teams
• Perform other duties as assigned and comply with all company policies and standards

Story Behind the Need:
This team supports a short-term initiative to transition an estimated 100K members from a competitor exiting the market. The goal is to ensure members have a positive onboarding experience, maintain continuity of care, and resolve any issues arising from provider, pharmacy, or benefits changes. These roles are part of a larger hiring initiative to accommodate the influx of new members.

Typical Day:

• Handle inbound calls from members regarding prior authorizations, care management, and provider assignments
• Use data and reports to support departments with existing PAs, care management episodes, and high-risk member transitions
• Ensure timely resolution of member issues and maintain call/note volume requirements
• Opportunity to develop best practices for managing large-scale member transitions

Candidate Requirements:

• Education: Bachelor's degree
• Experience: 2-4 years relevant experience
• Skills:


• Organization
• Proficiency in Excel
• Ability to collaborate across teams and departments

Interested candidates please send resume in Word format Please reference job code 247647 when responding to this ad.