Department/Program: Population Health
Reports To: Senior Director, Population Health
Supervises: Care Management Team members
Health Federation of Philadelphia is launching a new care management program aimed at reducing health inequities, addressing social determinants of health, and improving health outcomes for low-income patients struggling with chronic physical and mental health diseases. This is a ground floor opportunity in program development. We are seeking a dynamic leader with a background in social work or nursing who has clinical and case management experience and is familiar with the pace of, and populations served by, community-based health care providers in Philadelphia.
During the start-up phase, this individual will work with the Senior Director of Population Health and other staff and consultants to develop the program approach, including data systems, workflows, and team roles. The successful candidate will help to hire and then supervise the other team members, currently envisioned as a Nurse and two Community Health Workers. The team will work with six community health centers and a Medicaid Managed Care Organization (MCO) to achieve improved outcomes for health center patients enrolled with the MCO. Following the startup phase, the Team will work to assess needs of identified patients at high risk of poor health outcomes, and to engage these individuals in primary care and other services, with the goals of improving health status and reducing hospitalizations, as well as to address quality metrics across the whole attributed population.
- Provide direct supervision and guidance to team members.
- Collaborate in the development of a centralized care management and quality improvement program, including defining roles and hiring team members.
- Create and implement workflow, processes, and ancillary materials for patients attributed to health centers and designated as “high risk”.
- Lead the program implementation and provide ongoing development and modifications as needed.
- Provide direct care management services to patients living with chronic disease.
- Coordinate with health centers to review quality metric data, discuss workflow and documentation, and strategize about gaps in care.
- Communicate regularly with MCO team regarding patients and metrics.
- Manage the ongoing evaluation, review, and modifications of the program through the development phase.
- Develop ongoing relationships with health center partners and MCO team members to maintain and build program and service deliverables.
- Master’s degree in social work (licensed or license eligible preferred) or related field, or licensure as an RN.
- 3-5 years of experience with program development, project management and staff supervision. Experience with a start-up project/program is a plus.
- 3-5 years of experience providing care or case management services to low-income individuals struggling with chronic physical and/or mental health conditions.
- Understanding of managed care arrangements.
- Experience working in primary care practice or outpatient behavioral healthcare settings
- Understanding of the workflows and challenges of busy primary care offices.
- Some clinical behavioral health background highly desired.
- Community health center and/or Medicaid program experience a plus.
- Experience hiring and supervising community health workers, peer support workers or peer recovery workers.
- Adept with technology and data.
- Ability to work independently and a desire to build a program from start-up.
- Excellent written and verbal communication skills.
- Ability to work with patients in language other than English (especially Spanish) a big plus, but not a requirement.
Position Type and Work Schedule
This is a full-time, exempt position.
Standard office setting, plus regularly scheduled meetings, trainings, etc. with participating health centers.
Able to sit and work at a computer keyboard for extended periods of time. Able to lift and move up to 15 pounds.
Must be able to get around effectively within Philadelphia and surrounding counties, either on public transportation and/or in own vehicle. Limited travel beyond surrounding counties will be required, as well.
Our employees are our most valuable resource, so we offer a competitive and comprehensive benefits package, which can include:
- Medical with vision benefits
- Dental insurance
- Flexible spending accounts
- Life, AD&D and long term care insurance
- Short- and long-term disability insurance
- 403(b) Retirement plan, with a company contribution
- Paid time off, including vacation, sick, personal and holiday
Employee Assistance Program
Eligibility and participation is handled consistent with the plan documents and HFP policy.
The Health Federation reserves the right to modify, interpret, or apply this job description in any way the Company desires. The above statements are intended to describe the general nature and level of work being performed by an employee assigned to this position. This job description in no way implies that these are the only duties, including essential duties, responsibilities and/or skills to be performed by the employee occupying this position. This job description is not an employment contract, implied, or otherwise. The employment relationship remains “at will.” The aforementioned job requirements are subject to change to reasonably accommodate qualified disabled individuals.
The Health Federation of Philadelphia (HFP) is an Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation or preference, marital status or any classification protected by federal, state or local law.