Field Based Care Manager - JHP

Job Details

Job Description

• Must be willing to support Jefferson Health Plans mission.
• Make home visits to JHP members.
• Ensure timely care management appoints and scheduling.
• Evaluates the necessity, appropriateness and efficiency of services provided.
• Develops, coordinates and assists in implementation of member's individualized plan of care.
• Ensure timely member follow up.
• Will encourage member participation and compliance with their health care regimen.
• Coordinates the delivery of high quality cost-effective care based on member needs.
• Establish working relationships with community resources in the community.
• Research resources and be a resource advocate for JHP members.
• Documents accurately and comprehensively based on JHP policies and procedures.
• Maintain up to date knowledge of Medicare and Medicaid regulations and Medicaid regulations as it relates to the needs of the JHP Medicare members.
• Establish unit objectives in collaboration with the Manager, identify, select and apply guidelines, procedures and processes to meet department goals.
• Support the development of policies and procedures, workflows, and operational guidelines to assist in the management of members in the FBCM program
• Ensure compliance with program goals.
• Elevates member's satisfaction by addressing medical and social gaps internally and externally while following JHP policies. .
• Mentor/Orients new staff members and documents the content of orientation.
• Keep current on existing programs in community as well as population needs.
• Refer appropriate cases to other clinical programs or departments within Jefferson Health Plans to assist with quality of care and utilization management;
• Other duties as assigned.

Education:

Required:

• Registered Nurse, Licensed Practical Nurse or Masters of Social Work. Required licensure must be active in the Commonwealth of Pennsylvania.
• Preferred: 3-5 years of care management experience.
• Preferred: home care/community based experience.
• Required: minimum of three (3) year experience in the health care delivery system/industry.
• Preferred: Experience working with Medicare/Medicaid populations.

Skills/Abilities:

• Requires strong organizational skills.
• Requires strong oral and written communication skills.
• Requires good PC skills and the ability to utilize Microsoft Office applications (Excel, Access, Word, etc.).
• Requires good problem solving and conflict resolution skills.

• Requires ability to work with limited daily supervision.
• Strong attention to detail; self-motivated.
• Strong critical thinking skills and ability to problem solve.
• Ability to give and receive supervision and performance feedback
• Ability to coach care team colleagues
• Ability to work flexibly to meet the needs of members.
• Sensitivity to unique/non-traditional life circumstances.
• Valid driver's license and proof of insurance.
• Able to travel throughout the Jefferson Health Plans service areas.

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.