Jeff Temp - Clinical Programs Care Coordinator (RN)

Job Details

Job Description

Primary Responsibilities:

• Daily communication with assigned vendors to include:
  • Processing of daily inpatient census of vendor assigned members to point person of assigned vendor
  • Monitoring census reports from vendors to ensure that HPP staff is aware of cases in CCMS. This may include sending reviews to appropriate Team Leaders or designated staff through Health Care Management Software
  • Communicating with vendors of updates in member's case that may impact their status with vendor
  • Monitor spreadsheets of vendor census to assist in locating more appropriate contact information as needed
  • Attach pertinent vendor notes/documents to member case in Health Care Management software
  • Participate in interdisciplinary team meetings as needed to demonstrate coordination of care
  • Outreach to members assigned to vendor as needed to coordinate services
  • Assist intermal HPP teams with referral process to assigned vendors.
• Assist Director with communications with internal HPP departments that may impact vendor relationship such as Pharmacy, UM, Provider Network and IT
• Provide appropriate Committee reports to demonstrate monitoring of vendor activity
• Participate in monitoring of vendor compliance with regulatory agencies that includes, NCQA, CMS, DOH, DOI and DHS
• Prepare annually, for HPP Quality Mangement Committee (QMC) ,Clinical Practice Guidelines that includes review and updates of existing guidelines, receommending new guidelines based on interaction with all Clinical Programs staff, preparation for QMC and notification to provider and members about existence of guidelines in line with NCQA QI Standards.
• Participate in work groups as assigned.
• Perform all other duties as assigned.

Key Job Requirements:

• Education: Graduate of accredited school of nursing, RN with current licensure in PA and minimum of 2 years in case management or similar background such as home care.
• Skills/Abilities: Excellent verbal and written communication skills. Strong analytical and problem solving skills. Strong organizational skills and ability to manage multiple priorities. Knowledge of NCQA standards preferred. Strong computer skills in Outlook, MS Word, Excel and Access preferred. Valid driver's license and insurance.

Medicare Advantage Compliance Statement : Compliance with all applicable rules, regulations and laws is a condition of employment. Employees must read and sign the Code of Conduct and be expected to perform their duties ethically and honestly.

Access To Protected Health Information: Health Care Management software and other existing HPP software necessary to perform duties as assigned.

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.