Job Details

Job Details
Following the policies and procedures of assigned Unit, this position provides comprehensive member centric care coordination also known as case management services to members identified and who are agreeable to case management services. This may include assessing member needs, determining with the member health care goals and an agreed upon schedule to achieve identified goals.

Job Description

Essential Functions:

Able to work in a constant state of alertness and safe manner.
Assumes primary responsibility for providing case management for identified members who are agreeable to participating in case management. The care coordinator will continue case management services until the time that the member has reached agreed upon health care goals, or have opted out of case management, have lost eligibility, become lost to follow up or become decreased.
Conducts targeted outreach to members following department protocols. This includes verifying member eligibility using appropriate systems.

Assist primary care provider office(s) 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.
Coordinate with discharge planners for members who are require transition to alternative levels of care. Care Coordinators who assist members residing in pediatric congregate care facilities should have experience in discharge planning.
Documents in software that includes capturing the member’s barriers to care, priority goals, plans of care and schedule for follow up.

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.
Researching and coordinating care with available community resources.
Researching and coordinating care with member’s behavioral health provider.
Educates members on their specific health care needs and care options, including palliative care, as appropriate.
Facilitates accommodations for members with language, communication, visual or mobility limitations.

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.
Support the mission of the Plan.
Other duties as assigned.

Required Education and experience:

Licensed Registered Nurse, , Licensed Social Worker or Social worker with at least 3 years of current clinical/case management experience.
Active license to practice professionally in the Commonwealth of PA is required.
Experience including medical/surgical, home care, DME, authorizations, discharge planning and case management is preferred.
Bachelor’s Degree or above preferred
Bilingual preferred
Certified Case Manager (CCM) certification preferred upon hire or must begin process to obtain within 1 year of hire and be certified by the 2nd year of hire.

Skills/Abilities:

Must present polished professional image.
Understanding of Managed Care health 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.
Valid driver’s license and insurance required.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

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

At Jefferson, we offer a comprehensive total rewards package designed to support the health and well-being of our colleagues and their families. It includes a wide range of benefits including competitive pay, health and retirement benefits, life and disability insurance, paid time off, educational benefits, financial and mental health resources and much more. Our diverse benefits offerings ensure you have the coverage and access to services you need to thrive both personally and professionally.

Health Partners Plans, Inc.

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