Job Description

Number of Positions In Requisition

1

Job Details

Works with minimal supervision to ensure that comprehensive, patient-centered quality of care, cost effective patient care is offered for members in need of care coordination. All care coordination follows NCQA standards for Complex Case Management and is based on evidence-based guidelines. Review medication profiles member history verify appropriate testing and facilitate office visits with primary care and specialist physicians for members targeted for care coordination services. Coordinate with hospital and provider office case managers, as applicable, to ensure continuity of care and outpatient services when medically appropriate. Coordinate with behavioral health to ensure continuity of care and develop care plans. Perform outreach, education,

and follow-up to members based on criteria determined by Operational Guidelines. Utilize community resources to assist in coordinating care to maximize positive health outcomes. Collaborate with other members of Health Partner Plans to perform targeted outreach directed at improving outcomes through screenings and preventive health. Work with practice sites to remove

barriers to care, improve member self-management and improve member outcomes.

Job Description

• Able to work in a constant state of alertness and safe manner.
• Conduct timely telephonic outreach to members who have chronic conditions to improve health outcomes to include but not limited to assisting primary care provider offices in coordinating care of members with complex medical needs, utilizing appropriate assessments in software.
• Coordinating care for members that is member focused, taking into account the members barriers to care and their personal goals, and documentation within the software that captures the members barriers to care, priority goals, plans of care and schedule for follow up.
• Assumes primary responsibility for providing case management for identified members, including home, hospital and provider/ community site visits as appropriate.
• Assist primary care provider offices and specialist offices in coordinating care of members. Facilitates accommodations for members with language, communication, visual, or mobility limitations.
• Applies knowledge of pathophysiology, psychosocial issues, confidentiality, ethical/legal issues, and therapeutic interventions and sources to assist the membership with problem-solving/decision-making that promotes health, improves level of functioning, and decreases inappropriate use of services.
• Educating members concerning their specific health care needs and care options, including palliative care as appropriate, and researching and coordinating care with available community resources.
• Researching and coordinating care with member’s behavioral health provider and MCO. Collaborate with Behavioral Health MCO and the members to develop, assist with implementation of, and follow up on interdisciplinary care plans for members with serious persistant mental illness (SPMI).
• Informing members about Health Partners Plans Medicaid benefits and providing approved educational materials to members that support goals and interventions.
• Coordinate and collaborate care with external as well as internal Health Partners Plans resources to meet the individual needs of the member identified by the assessment and subsequent outreach. Refer appropriate cases to departments within Health Partners Plans to assist with quality of care and utilization management.
• Perform internet searches and follow up to date clinical guidelines in coordinating member care and services. Keep current on existing programs within the community as well as the needs of the population.
• Actively participate in multidisciplinary team meetings to represent care coordination program; Meetings include, but not limited to, Medical Director Rounds and BH Collaborative Meeting. Seek guidance from the assigned Medical Director or designee as appropriate.
• Balances the dual roles of advocacy for the member and stewardship of fiscal resources by assisting the member to identify and utilize all available resources.
• Work collaboratively within the Health Care Management department on tasks as needed. Participates in multidisciplinary and interdepartmental collaboration, reporting and special projects as assigned.
• Support Health Partners Plans mission
• Other duties as assigned that may include but not limited to performing responsibilities of other HPP care management units.

Education Required • Associate’s Degree

Education Preferred • Bachelor’s Degree

Experience - Required • 3 years current clinical/case management experience

Knowledge, Skills and Abilities - Required • Must present polished professional image. • Understanding of managed care delivery systems. • Ability to work and communicate effectively with co-workers, members, and providers. • Must be organized, detailed oriented, and capable of handling multiple issues. • Excellent telephone and verbal/written communication skills. • Demonstrated functional ability in navigating company software programs and basic computer applications, including, but not limited to Microsoft Office suite. • Active license to practice professionally in the Commonwealth of PA is required

Knowledge, Skills and Abilities - Preferred • Experience including medical/surgical, home care, DME, authorizations, and case management • Bilingual in a language spoken by membership is preferred

Licenses and Certifications - Required • RN - Licensed Registered Nurse_PA - State of Pennsylvania OR LPN - Licensed Practical Nurse_PA - State of Pennsylvania OR LSW - Licensed Social Worker - State of Pennsylvania

Licenses and Certifications - Preferred • CCM - Certified Case Manager - Commission for Case Manager Certification within 2 Years

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educa­tional and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

Benefits

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

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