Care Coordinator Medicare

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 

We are seeking a talented and enthusiastic Care Coordinator, Medicare to join our team!

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 criteria determined by Operational 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.

As the Care Coordinator, Medicare, your daily duties may include: 

• 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.
• 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. 
  
  

Qualifications

• Licensed Registered Nurse, Licensed Practical Nurse, Licensed Social Worker or Social worker with at least 2 years of case management experience, 
  
• Active license to practice professionally in the Commonwealth of PA is required.
  
• Experience in a medical setting and care coordination preferred.

 Skills, We Value: 

• Bilingual-Spanish speaking preferred
  
• 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.