Connected Care Specialist

Thomas Jefferson University & Jefferson Health; Philadelphia (Philadelphia County); On-site; USD 50,000 - 70,000; Full time

Job summary

A leading healthcare provider in Philadelphia seeks a dedicated professional to manage patient referrals and coordinate services for individuals with complex health-related social needs. The role requires strong communication and time management skills, along with a commitment to service excellence. Candidates should possess a relevant degree and experience in healthcare or case management.

Qualifications

• Minimum of 3 years’ experience in healthcare or related fields.

Responsibilities

• Manage and coordinate referrals to community and government services.
• Conduct HRSN assessments and critical screenings.
• Document client interactions in electronic health record system.

Skills

Cultural Competence

Time Management

Education

Associate or bachelor's degree in public health

Job description

Job Details

This role involves managing and coordinating referrals to community and government services to ensure comprehensive support for patients with complex Health-Related Social Needs (HRSN). It includes conducting in-depth patient assessments, identifying the best-fit resources considering patient needs, resource eligibility, and insurance benefits, implementing optimal referrals, and troubleshooting challenges in service delivery. At the team level, the role involves serving as a team leader to coordinate patient caseload management, ensure case loop closure, and collaborate with other referral specialists and leadership for continuous performance improvement. Supervision of screening and referral staff may be required.

Job Description

Essential Functions

• Interact with co-workers, visitors, and staff in alignment with Jefferson’s values.

Patient Experience and Service Excellence

• Provide exceptional service, resolve transactions professionally, and ensure a positive patient experience reflecting our commitment to effective care connections. Demonstrate dedication to service excellence and follow-through.

Case Review and Resource Allocation

• Review cases referred to determine assistance needed based on HRSN and screening results, engaging with patients for clarification and collaborating with care team members when necessary.
• Triaging cases to assign to team members for efficient workload management.
• Identify and implement suitable resources based on eligibility criteria such as medical history, insurance, and screening results.
• Track outcomes of referrals and identify workflow gaps to inform process improvements.

Screening and Referral Activities

• Conduct HRSN assessments and critical screenings in clinical and community settings.
• Document results accurately and communicate screenings to relevant staff.
• Implement referrals for services like cancer screenings, transportation, insurance, nutrition, housing, and safety.
• Educate and guide patients on accessing resources and assist with paperwork for program approval.
• Follow-up with patients to ensure receipt of services and schedule appointments as needed.

Collaboration and Communication

• Coordinate with the care team on HRSN results, interventions, and referral outcomes.
• Engage with patients and community members to clarify needs and troubleshoot referrals.
• Work closely with Connected Care Services staff and leadership to address challenges.
• Supervise supporting staff in screening and follow-up activities as needed.
• Maintain regular contact with community-based organizations to update on capacity, eligibility, and workflows.
• Support ongoing refinement of resource lists across the region.
• Liaise with CBOs to troubleshoot specific patient referrals and workflow issues.

Documentation and Time Management

• Accurately document all client interactions and care coordination activities in the electronic health record system and other relevant software.
• Maintain records of challenges and workflow issues to inform improvements.
• Demonstrate strong time management skills to handle referrals efficiently.

Cultural Competence

• Apply cultural humility in interactions to ensure respectful and effective communication.

Education Requirements

Associate or bachelor's degree in public health, healthcare administration, or a related field is required.

Minimum of 3 years’ experience in healthcare, benefits assistance, inpatient coordination, research, public health, case management, or customer service is required.

Work Shift

Rotating (United States of America)

Worker Sub Type

Regular

Primary Location Address

914 Chestnut Street, Philadelphia, Pennsylvania, United States of America

Jefferson, located mainly in the Philadelphia region, Lehigh Valley, Northeastern Pennsylvania, and southern New Jersey, is reimagining healthcare and higher education to create value. With over 65,000 staff, Jefferson provides high-quality clinical care, promotes community health, educates future professionals, and advances research through its various colleges and schools.