Job ID: J119480
Company: Highmark Inc
Location: Pittsburgh, PA, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Apr 19, 2018
This job owns and conducts oversight over a specified panel of inpatient members that range in health status/severity and clinical need. The incumbent assesses health management and psychosocial needs of the assigned member panel and utilizes data/analytics, in conjunction with clinical judgement and hospital care team insight, to identify the right clinical intervention for each member and support the discharge planning process. The incumbent supports multiple teams and processes from both the Provider and Health Plan. The incumbent works within facility processes to coordinate, connect, and collaborate in order to identify and address barriers, eliminate redundancies, streamline inefficiencies and improve member satisfaction and outcomes. The incumbent serves as an embedded resource to gather relevant information, assist in discharge planning options, help resolve barriers and placement issues, and refer members to appropriate resources post discharge. The incumbent conducts face to face member visits as needed for the purposes of providing real-time support for utilization and case management needs, participating in discharge planning and transitions of care, initiating plans of care and making introductions and referrals to Highmark programs and resources. The incumbent monitors, improves, and maintains quality outcomes (clinical, financial and functional) for the specified panel with the primary objective to improve member experience by strengthening enterprise utilization and case management.
LICENSES AND CERTIFICATIONS
Language (Other than English)
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Teaches / trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
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