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 AVP, CHC Clinical ( Program Manager) to join our team!

The full‐time AVP, CHC Clinical ( Program Manager) is responsible for the operations of CHC. This position provides leadership and oversight for all areas of service coordination and care management of CHC NFCE and aligned/unaligned NFI participants. This position oversees the performance of any contracted Support Coordination Entities (SCEs). The CHC Program Manager also leads staff and functions supporting service coordination including training, caregiver support, participant advocate/peer supporters, community health workers, behavioral health coordination, and community outreach. They are responsible for maintaining positive working relationships with external parties active in the LTSS space including Area Agencies on Aging (AAA), Centers for Independent Living (CIL), SCEs and other community organizations.

As the AVP, CHC Clinical (Program Manager), your daily duties may include:

• Able to work in a constant state of alertness and safe manner.

• Manage internal service coordination and SCE processes including quality, compliance, and staffing.

• Ensure functions supporting service coordination have integrated, efficient and compliant processes.

• Serve as business user lead for the integrated case management system, interacting with other IT and business process SMEs.

• Support and provide input on Quality activities and initiatives such as the achievement and maintenance of NCQA LTSS Distinction and setting annual HEDIS and CAHPs measures.

• Work across the health plan operating areas to develop and continually monitor appropriate Service Level Agreements for operational areas and coordination protocols for other departments including Quality, Utilization Management, and DSNP.

• Establish and maintain relationships with external parties that support successful LTSS performance including, but not limited to, SCEs, AAAs, CILs, advocacy groups, and community organizations.

• Routinely evaluate performance and continuously modify business approaches to improve performance.

• Maintain awareness of both the external and internal competitive landscape and recommend program enhancements, as warranted.

• Stay current with all pertinent regulatory and compliance requirements including but not limited to CMS, DHS, and OLTL.

• Conduct self in accordance with HPP code of conduct; ensure entire department also follows HPP corporate wide policies and procedures.

• Perform other duties as assigned.

Qualifications

• Current Pennsylvania state license to practice as a Registered Nurse (RN) or Social Worker required.
• Bachelor’s degree required, master's degree preferred.
• 7-10 years’ service coordination or case management experience with a minimum of 5 years in a management position preferred.
• 5 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, We Value

• Broad knowledge of DHS regulations as they relate to service coordination or case management required.
• Excellent oral and written communication skills.
• 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 interpersonal and communications skills.
• Strong independent decision-making skills.
• Strong influencing, negotiation, conflict resolution and analytical skills preferred.
• Demonstrated expertise in managing direct reports and cross functional relationships.
• Strong project management and organizational skills.
• Knowledgeable with respect to all aspects of LTSS.
• Experienced in managing to the bottom line, including development and management of budgets.