Care Progression Lead – Value-Based Care

Jefferson Health Plans; Philadelphia (Philadelphia County); On-site; USD 85,000 - 115,000; Full time

Job summary

Jefferson Health Plans seeks a Care Progression Manager to coordinate cross-disciplinary strategies for value-based care and payer population management. You will align care progression workflows with organizational goals for quality, efficiency, and cost-effectiveness.

The role focuses on progressing patients’ care based on medical criteria for inpatient status, with rotations and collaboration across clinical and operational teams at Thomas Jefferson University facilities.

Qualifications

• Bachelor’s Degree in Nursing.
• 5 years inpatient acute care hospital experience.
• Excellent communication (oral and written) required to facilitate reviews with providers.
• RN - Licensed Registered Nurse PA Upon Hire.
• RN - Licensed Registered Nurse NJ Upon Hire.

Responsibilities

• Oversee population to ensure timely progression of care, safe discharge planning, and appropriate post-acute services using evidence-based criteria.
• Identify patient clinical conditions, testing and value based clinical interventions that can be completed in the ambulatory space with appropriate follow-up.
• Apply clinical criteria to monitor medical necessity, reduce avoidable days, and resolve barriers to care in collaboration with physicians, nursing, and utilization management.
• Collaborates in the development and implementation of performance improvement activities in collaboration with care management, physician, utilization management.
• Interacts with co-workers, visitors, and other staff consistent with the values of Jefferson.
• Monitor length of stay, readmissions, and throughput metrics; identify trends; and contribute to initiatives that improve efficiency and patient outcomes.

Skills

Excellent communication

Education

Bachelor’s Degree in Nursing

RN license PA

RN license NJ

Job description

Jefferson Health Plans seeks a Care Progression Manager to coordinate cross-disciplinary strategies for value-based care and payer population management. You will align care progression workflows with organizational goals for quality, efficiency, and cost-effectiveness.

The role focuses on progressing patients’ care based on medical criteria for inpatient status, with rotations and collaboration across clinical and operational teams at Thomas Jefferson University facilities.