Behavioral Health Coordinator

Job Details

The Behavioral Health (BH) Coordinator at Jefferson Health Plans will support the integration of behavioral and physical health services across the member population. This position is responsible for coordinating care for members with behavioral health needs with a strong focus on improving quality outcomes, closing care gaps, and addressing barriers that impact overall health. The BH Coordinator will partner closely with internal teams and external providers to ensure alignment with performance metrics, including HEDIS, Pennsylvania Performance Measures (PAPM), and the CMS Core Measure Set. This role promotes whole person care through collaborative, data driven interventions.

Job Description

Summary
The Behavioral Health (BH) Coordinator at Jefferson Health Plans will support the integration of behavioral and physical health services across the member population. This position is responsible for coordinating care for members with behavioral health needs with a strong focus on improving quality outcomes, closing care gaps, and addressing barriers that impact overall health. The BH Coordinator will partner closely with internal teams and external providers to ensure alignment with performance metrics, including HEDIS, Pennsylvania Performance Measures (PAPM), and the CMS Core Measure Set. This role promotes whole person care through collaborative, data driven interventions.

Job Duties

• Conduct outreach and engagement with members to promote adherence to treatment plans, preventive services and care coordination activities. Whenever feasible, face-to-face outreach will be conducted in the community, in medical settings, or at the member's home.
• Coordinate care for members with behavioral health conditions, including those with serious mental illness, substance use disorders, and co-occurring chronic medical conditions.
• Facilitate transitions of care, including post-discharge follow-up from inpatient or emergency department visits for behavioral health conditions.
• Collaborate with primary care providers, behavioral health providers, JHP care managers, community-based organizations and behavioral health managed care organizations (BH-MCOs) to develop and implement integrated care plans.
• Identify and address barriers to care, including health-related social needs (e.g. housing instability, lack of transportation, and food insecurity), health literacy and system navigation challenges.
• Support JHP quality initiatives by identifying and closing gaps in care related to behavioral and physical health.
• Monitor and track performance measures, such as HEDIS and other state/federal quality metrics. Develop improvement strategies and interventions.
• Document care coordination activities in accordance with regulatory and organizational requirements.
• Participate in the identification of best practices for behavioral health in a primary care setting.
• Be knowledgeable of the BH Managed Care Agreement requirements and coordinate with the BH-MCO to effectuate the requirements.

Minimum Qualifications

• Bachelor’s Degree Social work, psychology, nursing, public health, or related field
• 5+ years of direct care experience in behavioral health, care/case management, or managed care
• Experience in patient assessment and care plan development
• Experience in identifying and connecting to community resources and supports
• Knowledge of HEDIS measures, quality improvement processes, and population health strategies
• Strong clinical and case management skills
• Strong understanding of integrated care models and health-related social needs
• Understanding of crisis intervention principles and conducting suicide risk assessments
• Understanding of mental health and substance use diagnoses, modes of treatment, and barriers to care for individuals with mental illness
• Understanding of HIPAA regulations and patient confidentiality laws
• Ability to maintain strict confidentiality and ethical standards
• Cultural competence and experience working with diverse populations
• Understanding of principles of trauma-informed care
• Strong written communication skills
• Ability to work with cross-functional teams

Preferred Qualifications

• Master’s Degree Psychology or social work
• Experience working with Medicaid, CHIP or Medicare populations
• Proficiency in care management systems, EHRs
• Bilingual
• Familiarity with PA's behavioral health treatment landscape, including behavioral health managed care organizations and integrated care planning
• LSW - Licensed Social Worker - State of Pennsylvania
• CCM - Certified Case Manager - Commi