Care Transformation Specialist at Horizon Blue Cross Blue Shield of New Jersey Job Listing at DirectEmployers in Newark, NJ (Job ID 3851950-2024-08-04)

Description

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Job Summary:

The Care Transformation Specialist will support Horizons Value-Based programs by working with multidisciplinary frontline clinical personnel, including physicians and nurses, within multiple care delivery settings for the entire spectrum of patient population. This person will mentor the frontline staff on promoting patient-centered care, on maintaining frequent contact with primary care providers and care team members and on effectively participating in multidisciplinary patient-centered team meetings. Care Transformation Specialist will be responsible for coordinating the medical neighborhood and working with frontline clinical staff, interacting and communicating with multidisciplinary teams either telephonically and/or in person along the continuum of care on creation and management of medical neighborhood including but not limited to hospitals, primary care, specialty care, dialysis facilities, post acute care, home care, ancillary care, community resources and Horizon programs. This is a key role in the transformation of the medical practice into a Patient-Centered Medical Home and transforming hospital systems to perform value.

Responsibilities:

• Works with internal and external stakeholders to help identify high risk, high need, and potentially high cost patients as well as the development of interventions to manage those members.
• Creates and facilitates customized Value-Based trainings, including in-services, WebExs, and other educational materials for internal and external partners (e. g. Value-Based programs, motivational interviewing, etc.) to drive learning collaboration and healthcare delivery transformation to focus on population health.
• Coaching and mentors Population Care Coordinators, ED Navigators and other frontline staff to implement best practices around Care Transition Coordination and Population Health Management.
• Develops constructive relationships with frontline personnel throughout a medical neighborhood in order to develop systems, processes and initiatives to engage these entities in relevant care management activities with each Horizon insured member to ensure that all necessary transition needs are met.
• Monitors practice to ensure care is coordinated with all resources, both within a system and in the community. Facilitates practice information flow between all members of the care team.
• Leads practice implementation of processes for best practices for preventive services, chronic care and disease management including utilization of tools to prioritize patient needs. Monitors practice to make sure follow-up primary care visits are obtained in a timely manner and that visits include all appropriate post transition care.
• Collaborates with practice on working with the patient to create plans of care and work to improve patient self-management and adherence to the plan of care.
• Provides techniques to practice to achieve improved outcomes such as motivational interviewing and coaching, group visits, advanced scheduling and the incorporation of behavioral health tools and resources into practice.
• Works with practice to improve the patient experience and member satisfaction through changes in the service delivery model.
• Monitors the practice to assure that appropriate home care, hospice care, and other ancillary services (DME, infusion services etc.) are in place and are being delivered as directed by the care team with communication and coordination in place.
• Coordinates with practice of necessary referrals and authorizations with Horizon care management areas and tracking follow-up visits and communication with appropriate specialists and patients including regarding testing.
• Educates provider staff on Value Based models o

  Compensation Information:
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  Starting At: 0.0
  Up To: 0.0

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