Care Coordinator Medicare - Jefferson Health Plan

Care Coordinator

Works with minimal supervision to ensure that comprehensive, quality, cost effective patient care is offered for members in need of care coordination. Review medication profiles, verify appropriate testing, and facilitate office visits with primary care and specialist physicians for members targeted for care coordination services. Coordinate with hospital case managers to ensure continuity of care and outpatient services when medically appropriate. Coordinate with behavioral health to ensure continuity of care. Perform outreach, education, and follow-up to members based on criteria determined by Operational Guidelines. Utilize community resources to assist in the coordination of care to maximize positive health outcomes. Assist as needed in the HEDIS data collection project and collaborate with various other members of Health Partners Plans in performing targeted outreach directed at improving outcomes through screenings and preventive health.

Job Description

• Able to work in a constant state of alertness and safe manner.
• Conduct timely outreach to members either telephonically or by visiting member in their home for those who have chronic conditions/high utilization and are non-compliant with medications and treatment regimens to improve health outcomes and to include but not limited to:
• Utilizing appropriate assessments in medical management system;
• Coordinating care and developing Care Plans for members that are member centric, taking into account the member's barriers to care and their personal goals.
• Documentation in medical management system that includes capturing the member's barriers to care, priority goals, plans of care and schedule for follow up.
• Educating members concerning their specific health care needs;
• Researching and coordinating care with available community resources.
• Researching and coordinating care with member's behavioral health provider.
• Informing members about Jefferson Health Plans Medicare benefits.
• Mailing literature that supports goals and interventions.
• Coordinate and collaborate care with external as well as internal Jefferson Health Plans resources to meet the individual needs of the member identified by the assessment and subsequent outreach.
• Assist primary care provider and specialist offices in coordinating care of members.
• Perform literature searches and follow up to date clinical guidelines in coordinating member care and services.
• Track assigned cases for timely interventions and trend for disease specific outcomes.
• Regularly collaborate to evaluate and improve care coordination programs to ensure appropriate medical management.
• Actively seek guidance from assigned Medical Director or designee as appropriate.
• Actively participate in multidisciplinary team meetings to represent care coordination program.
• Function as a liaison for the member internally at Jefferson Health Plans
• Work collaboratively within the Health Care Management department on tasks as needed.
• Refer appropriate cases to departments within Jefferson Health Plans to assist with quality of care and utilization management;
• Actively aware of Corporate and department goals.
• Other duties as assigned.

Education and Experience:

• High School Diploma/GED
• LPN, RN, LSW license required in State of PA
• Associate's Degree in Nursing
• Master's Degree in Social Work
• 2 years case management experience
• Understanding of Medicare Managed Care delivery systems.
• Ability to work and communicate effectively with co-workers, members, and providers.
• Organized, detailed oriented, and capable of handling multiple issues.
• Excellent telephone and verbal/written communication skills.
• Computer Literacy and experienced with Microsoft Word, Excel and Outlook.
• LPN, RN, LSW license required in State of PA
• Bilingual-Spanish speaking preferred

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