Director, Service Coordination (LTSS)

Why Choose Jefferson Health Plans?

We are an award-winning, not-for-profit health maintenance organization offering Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We are committed to creating a community where everyone belongs, acknowledges, and celebrates diversity and has opportunities to grow to their fullest potential.

While this job currently provides a flexible remote option, due to in-office meetings, training as required, or other business needs, our employees are to be residents of PA or the nearby states of DE or NJ.

Perks of JHP and why you will love it here:

• Competitive Compensation Packages, including 401(k) Savings Plan with Company Match and Profit Sharing
• Flextime and Work-at-Home Options
• Benefits & Wellness Program including generous Time Off
• Impact on the communities we service

The full‐time Service Coordination (SC) Director oversees all Service Coordination functions of Jefferson Health Plans Community HealthChoices (CHC) Program reporting structure. The SC Director is responsible for all Service Coordination functions, whether the HPPs’ CHC Program provides all Service Coordinator functions in house or contracts with outside entities to meet Service Coordination requirements. The SC Director ensures that all regulatory requirements are met that are appropriate to HPPs’ CHC Program, including NCQA and HEDIS requirements. This position has overall responsibility and oversight of a dedicated and committed Service Coordination team. The SC Director oversees registered nurses, licensed practical nurses, social workers and non-licensed staff. The SC Director proactively anticipates and identifies causes of interruption in unit functions and takes appropriate action to meet performance expectations. The SC Director promptly reports staffing changes or external influences will negatively impact program performance to the LTSS Director, CHC Program Manager and CHC Administrator.

PRIMARY RESPONSIBILITIES:

• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Able to work in a constant state of alertness and safe manner.
• Manage highly skilled staff to meet and exceed Service Coordination requirements and functional objectives.
• Manage highly skilled staff to meet and exceed requirements and functional objectives for non-clinical responsibilities.
• Recruit, attract, develop, motivate and retain high caliber team members.
• Maintain a positive work environment that supports self-direction; provides a structure to optimize experience, skill, knowledge and capability of the team.
• Reward the team based on contribution and performance.
• Work with the CHC Trainers to develop and maintain training documentation, operational standards and procedures, policies and procedures in accordance with regulatory requirements.
• Coach and lead team to continuously improve operational performance.
• Ensure Service Coordination team is incorporating Person-Centered Thinking/Person-Centered Planning practices into Service Coordination activities and processes.
• Work with staff to establish annual goals; monitor via staff performance evaluations (interim and annual); address performance and program issues with performance improvement and/or corrective action plan(s), as applicable.
• Develop mechanisms to support interdepartmental coordination of Service Coordination efforts.
• Seek and obtain training opportunities dependent on department needs in collaboration with other clinical program areas.
• Actively participate in committees and workgroups being mindful of budget, resources and capabilities of the staff.
• Review, amend, and develop tools for Service Coordination referral systems, tracking, reporting formats, and documentation to meet participant needs as well as reporting requirements.
• Oversee the development, review and amendments of Service Coordination policies and procedures, standard operating procedures, and job aids.
• Ensure all regulatory reports are developed and filed in a timely manner with appropriate agency.
• Assist with developing Complex Care Unit (CCU) educational presentation topics for use both internally and externally in collaboration with other clinical programs areas and SCEs.
• Develop and maintain collaborative relationships with the external SCEs to ensure that lines of communication are open and transparent.
• Perform other duties as assigned.

KEY JOB REQUIREMENTS:

REQUIRED EDUCATION AND EXPERIENCE:

• Current Pennsylvania state license to practice as a Registered Nurse (RN) or Social Worker required.
• Bachelor’s degree required.
• 5-7 years’ service coordination or case management experience with a minimum of 3 years in a management position preferred.
• 2 years of Managed Care experience with knowledge of service coordination or case management, NCQA Accreditation, and HEDIS, in a managed healthcare environment, preferred.
• CCM certification preferred upon hire or must be obtained within 2 years of hire.
• Person-Centered Thinking or Person-Centered Planning experience preferred.

SKILLS/ABILITIES:

• Broad knowledge of DHS regulations as they relate to service coordination or case management required.
• Excellent writing and communication skills required.
• Excellent organizational performance and achievement of goals.
• Capable of individual initiative, self-starter.
• Computer skills necessary with emphasis on Microsoft Office and Database applications.
• Excellent organizational, interpersonal, time management and communications skills.
• Strong leadership skills.
• Strong conflict resolution and independent decision-making skills.
• Expert process and project management ability preferred.
• Strong influencing, negotiation and analytical skills preferred.