Transitions of Care Manager, Jail

Community Health Plan of Washington is an equal opportunity employer committed to a diverse and inclusive workforce. All qualified applicants will receive consideration for employment without regard to any actual or perceived protected characteristic or other unlawful consideration.

Our commitment is to:

• Strive to apply an equity lens to all our work.
• Create an equitable work environment.

About the Role:

The Licensed Carceral Transitions of Care Manager (CT CM) is responsible for pre-release planning and short-term case management of members releasing from city and county jails, Department of Corrections, JR, and JD facilities, ensuring they are safely and effectively transitioned back into community settings. Provides short-term care management services for members with highly complex behavioral health, medical, and social conditions. Working within a multi-functional team, the CT CM connects with members, correctional facility staff, providers, caregivers, contracted vendors, community resources, and health plan partners to assess the member's reentry into the community, identify care needs, and ensure access to appropriate services to achieve positive health outcomes.

This position is temporary, scheduled to end in June of 2028.

To be successful in this role, you:

• Have a current, unrestricted license in the State of Washington as a Registered Nurse (RN), or Social Worker (LICSW or LASW), required.
• Have a background in behavioral health, experience working with diverse populations, or collaborating with justice involved individuals.
• Have experience with community resources such as Regional Centers, Medicaid mental health and substance abuse services.
• You currently possess or have the ability to obtain a National Provider Identifier (NPI) number and register with Washington State Medicaid Provider One.
• Possess a valid WA driver's license and have access to a reliable automobile.

Essential functions and

Roles and Responsibilities:

• Identifies, locates, and determines custody status of Apple Health Fee-for-Service justice involved members. Advocates on behalf of and facilitates coordination of resources required to help justice involved members reach optimum functional levels upon reentry to the community during transition and provides short-term case management.
• Works with the city and county jails, Department of Corrections facilities, and Juvenile Rehabilitation facilities and a multi-functional team to connect with providers, caregivers, contracted vendors, community resources, and health plan partners to assess the member's health status, identify care needs and ensure access to appropriate services to achieve positive health outcomes upon reentry to the community.
• Performs the primary functions of assessment, planning, facilitation, and advocacy through collaboration with the member, city and county jails, Department of Corrections, and Juvenile Rehabilitation facilities and other health care resources involved in the member's transition post-release.
• Meets with the justice involved members via phone or video conferencing at city and county jails, Department of Corrections, and Juvenile Rehabilitation facilities.
• Documents all case activity using the CHPW care management system and follows documentation standards and protocols.
• Participates in telephonic and/or video discharge planning meetings and interdisciplinary care conferences, when appropriate and necessary.
• Schedules medical, mental health, dental, and/or vision appointments in accordance with the member’s release date. Schedule transportation to appointments if required.
• Conducts comprehensive social determinants of health (SDoH) assessments and coordinates care plan needs to address identified gaps.
• Communicates with members pertinent…