Care Coordinator - JHP

Job Details

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 case manager 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.
  • This may include calling hospitals, provider offices, pharmacies, home care agencies to locate member's most recent phone number.
  • Outreach may include telephonic, virtual and face to face in the community with member's approval.

• 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.
• Informing members about their plan benefits.
• 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.
• Provides approved educational materials that supports goals and interventions.

• Perform literature searches and follow up to date clinical guidelines in coordinating member care and services.
• Actively seek guidance from assigned Medical Director or designee as appropriate.
• Keep current on existing programs within the community as well as the needs of the population.
• 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.
  • This may include providing the member with steps in filing a member complaint or grievance.
• Support the mission of the Plan.
• Other duties as assigned.

Collaboration:

• Actively participate in multidisciplinary and interdepartmental team meetings, OCYI regional offices as applicable to represent care coordination program; Meetings include, but not limited to, Medical Director Rounds and BH Collaborative Meeting.

• Collaborate with behavioral health MCOs and the member to develop, assist with implementation of, and follow up on interdisciplinary care plans (ICP) for members with serious, persistent mental illness (SPMI).

• Work collaboratively within the Health Care Management department on tasks as needed which may include QM, UM, and Pharmacy.
• Coordinate and collaborate care with external as well as internal Plan resources to meet the individual needs of the member identified by the assessment and subsequent outreach.

Reporting:

• Document in the appropriate software following Unit's protocol all actions following the training and policies and procedures.
• Recommend through appropriate channels methods of efficiencies that others may benefit from.
• Escalate issues/concerns following the direction of Team Lead and Manager.

Work Shift

Worker Sub Type

Primary Location Address

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.