Job Details

The Behavioral Health (BH) Coordinator at Jefferson Health Plans will support the integration of behavioral and physical health services across the member population. This position is responsible for coordinating care for members with behavioral health needs with a strong focus on improving quality outcomes, closing care gaps, and addressing barriers that impact overall health. The BH Coordinator will partner closely with internal teams and external providers to ensure alignment with performance metrics, including HEDIS, Pennsylvania Performance Measures (PAPM), and the CMS Core Measure Set. This role promotes whole person care through collaborative, data driven interventions.

Job Description

Summary
The Behavioral Health (BH) Coordinator at Jefferson Health Plans will support the integration of behavioral and physical health services across the member population. This position is responsible for coordinating care for members with behavioral health needs with a strong focus on improving quality outcomes, closing care gaps, and addressing barriers that impact overall health. The BH Coordinator will partner closely with internal teams and external providers to ensure alignment with performance metrics, including HEDIS, Pennsylvania Performance Measures (PAPM), and the CMS Core Measure Set. This role promotes whole person care through collaborative, data driven interventions.

Job Duties

• Conduct outreach and engagement with members to promote adherence to treatment plans, preventive services and care coordination activities. Whenever feasible, face-to-face outreach will be conducted in the community, in medical settings, or at the member's home.
• Coordinate care for members with behavioral health conditions, including those with serious mental illness, substance use disorders, and co-occurring chronic medical conditions.
• Facilitate transitions of care, including post-discharge follow-up from inpatient or emergency department visits for behavioral health conditions.
• Collaborate with primary care providers, behavioral health providers, JHP care managers, community-based organizations and behavioral health managed care organizations (BH-MCOs) to develop and implement integrated care plans.
• Identify and address barriers to care, including health-related social needs (e.g. housing instability, lack of transportation, and food insecurity), health literacy and system navigation challenges.
• Support JHP quality initiatives by identifying and closing gaps in care related to behavioral and physical health.
• Monitor and track performance measures, such as HEDIS and other state/federal quality metrics. Develop improvement strategies and interventions.
• Document care coordination activities in accordance with regulatory and organizational requirements.
• Participate in the identification of best practices for behavioral health in a primary care setting.
• Be knowledgeable of the BH Managed Care Agreement requirements and coordinate with the BH-MCO to effectuate the requirements.

Minimum Qualifications

• Bachelor’s Degree Social work, psychology, nursing, public health, or related field
• 5+ years of direct care experience in behavioral health, care/case management, or managed care
• Experience in patient assessment and care plan development
• Experience in identifying and connecting to community resources and supports
• Knowledge of HEDIS measures, quality improvement processes, and population health strategies
• Strong clinical and case management skills
• Strong understanding of integrated care models and health-related social needs
• Understanding of crisis intervention principles and conducting suicide risk assessments
• Understanding of mental health and substance use diagnoses, modes of treatment, and barriers to care for individuals with mental illness
• Understanding of HIPAA regulations and patient confidentiality laws
• Ability to maintain strict confidentiality and ethical standards
• Cultural competence and experience working with diverse populations
• Understanding of principles of trauma-informed care
• Strong written communication skills
• Ability to work with cross-functional teams

Preferred Qualifications

• Master’s Degree Psychology or social work
• Experience working with Medicaid, CHIP or Medicare populations
• Proficiency in care management systems, EHRs
• Bilingual
• Familiarity with PA's behavioral health treatment landscape, including behavioral health managed care organizations and integrated care planning
• LSW - Licensed Social Worker - State of Pennsylvania
• CCM - Certified Case Manager - Commission for Case Manager Certification

Additional Qualifications

Physical Demands
Lift and carry 25 lbs. frequent sitting/standing, frequent keyboard use, *patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.

Job Description Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.

Work Shift

Workday Day (United States of America)

Worker Sub Type

Regular

Employee Entity

Health Partners Plans, Inc.

Primary Location Address

1101 Market, Philadelphia, Pennsylvania, United States of America

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

Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.

For more benefits information, please click here