(610) 832-2001

 

Open Positions



We offer: Competitive pay, generous benefits, including 401K, medical and dental benefits, LTD, PTO, a flexible work schedule, partial telecommuting (after training period), and a friendly, business casual work environment.

ProgenyHealth is an Equal Opportunity Employer.



Send resume AND salary history to:
HR Department, ProgenyHealth
Email: jobs@progenyhealth.com
Fax: 484-362-6558

Case Manager – Pediatric Nurse

Job Description:

The Case Manager is a registered nurse managing the continuum of care for infants and their families. The Case Manager works in a telephonic managed care setting combining strong clinical knowledge and critical thinking to facilitate a care plan that will ensure quality medical care for the high-risk member population serviced by ProgenyHealth based on national standards for case management practice. The Case Manager will focus on empowering the family to support optimal wellness while advocating for necessary medical services.

Job Responsibilities:
  • Making introductory calls to families to provide them with an overview of our services
  • Completing needs assessments for all infants in case management and developing care plans individualized to the needs of each infant and their family
  • Stratifying infants based on their needs at the appropriate case management level and providing frequent outreach calls to manage ongoing needs
  • Interfacing with the infant’s PCP and other neonatal providers to assist with activities which can include coordinating appointments, transportation, medical equipment etc
  • Provides ongoing case management services to assist families after discharge as the primary contact to assist with care coordination needs throughout the first year of life
Job Requirements:
  • Registered Nurse (RN) with a current, unrestricted license is required
  • Three or more years of clinical experience in a pediatric environment
  • CCM preferred
  • Two or more years of managed care experience in a hospital, integrated health system or health plan in a case management and/or discharge planning role is preferred
  • Data entry skills required. Must be computer literate
  • Excellent communication skills and organizational ability is required. Must be self-motivated and willing to learn multiple tasks. Must be well organized and able to prioritize tasks
  • Must demonstrate accuracy in spelling and documentation
  • Ability to perform job functions with autonomy and be a self-starter
  • Demonstrated strength in working independently as well as collaboratively within a team environment
  • Must possess excellent interpersonal skills, telephone etiquette and maintain positive communication at all times
  • Must have commitment to excellence in customer service
Job Location:
  • Plymouth Meeting, PA


Send resume AND salary history to:
HR Department, ProgenyHealth
Email: jobs@progenyhealth.com
Fax: 484-362-6558

Case Manager – RN – 100% Virtual

Job Description:

The Case Manager will focus on empowering the members’ family to support optimal wellness while advocating for the necessary medical services across the health care continuum. The Case Manager works in a telephonic managed care setting combining strong clinical knowledge and critical thinking to facilitate a plan of care that will ensure quality medical care for the high-risk member population serviced by ProgenyHealth Inc. based on the CMSA national standards for case management practice.

Job Responsibilities:
  • Utilizes the case management process of engaging, assessing, planning, implementing, monitoring, and, evaluating the needs of the high-risk neonatal population
  • Initiating engagement with member’s caregiver during inpatient stay in order to support the treatment plan and discharge planning process.• Acting as a member advocate by the appropriate selection of services, based upon member’s benefits, for appropriate utilization of resources, and providing an ongoing evaluation of member outcomes
  • Referring members’ caregivers to community resources when appropriate and based upon client specific requirements
  • Working in a telephonic managed care setting, combining strong clinical knowledge and critical thinking to facilitate a plan of care that will ensure quality medical care for the high-risk member population serviced by ProgenyHealth Inc.
  • Developing care plans individualized to the needs of each infant and his/her family
  • Participating in case management rounds with ProgenyHealth and client teams to discuss barriers and opportunities to improve health outcomes
  • Collaborating with other ProgenyHealth staff, families, facility staff, community agencies, primary care and specialist offices to ensure that evidence-based protocols are utilized in treatment plan
  • Utilizing motivational interview skills to maintain caregiver engagement through the first year of member’s life.
Job Requirements:
  • Registered Nurse (RN) with a current, unrestricted license is required
  • Three or more years of clinical experience as a Pediatric/NICU nurse or Adult ICU* is required.
  • * If clinical experience is Adult ICU, candidate must have experience working in a health plan in a CM or discharge planning role.
  • NICU or Pediatric Intensive Care nurse preferred.
  • Five or more years of managed care experience in a health plan in a case management role is required.
  • Experience with Data entry into a database or EHR required. Must have strong computer skills.
  • Excellent communication skills and organizational ability is required. Must be self-motivated and willing to learn multiple tasks. Must be well organized and able to prioritize tasks
  • CCM certification highly desirable and is required after two years of employment
  • Ability to perform job functions with autonomy and be a self-starter
  • Must possess excellent interpersonal skills, telephone etiquette and maintain positive communication at all times
  • Must have commitment to excellence in customer service


Send resume AND salary history to:
HR Department, ProgenyHealth
Email: jobs@progenyhealth.com
Fax: 484-362-6558

 

Senior Vice President of Clinical Operations

Job Description:

The SVP of Clinical Operations will be responsible for administering the ProgenyHealth Medical Management program including responsibility for metrics, outcomes and results of the UM, CM and QM departments. This oversight will involve responsibility for utilization management, case management and quality management programs; the effectiveness of these programs; the results and outcomes, performance metrics development and monitoring; and measurement of the effectiveness of all clinical processes, internal and external, designed to accommodate the existing and rapid growth objectives of our organization.

Job Responsibilities:
      • Maintains and oversees the Utilization, Case and Quality Management Programs. Further develops meaningful and useful metrics and dashboards for individual/corporate staff accountability and monitors adherence and compliance with these dashboards to measure each program’s effectiveness.
      • Ensuring supervisors/managers/those with direct reports understand dashboards and are regularly holding their staff accountable for meeting their individual and plan/company metrics as applicable.
      • Knowledgeable about developing strong training programs, which includes using learning management systems to drive new staff onboarding, as well as training and education of existing staff.
      • Managing a growing remote workforce with appropriate tools and metrics, so results and outcomes are consistent across the company.
      • Assists with the implementation and successful launch of new clients, new product lines and/or technologies, as needed, to keep our program cutting edge and highly innovative in the marketplace.
      • Responsible for meeting/exceeding customer SLA’s and planning timely corrective actions, as needed, when program outcomes do not meet expectations.
      • Supports our company operating system (EOS- Entrepreneurial Operating System) so that all departments are following the same meeting cadence and solving problems.
      • Improves workflow and processes to be more efficient and effective in the delivery of ProgenyHealth services to its clients.
      • Oversight of compliance with PH policies and procedures, information security, URAC, NCQA, State, Federal and Client standards in carrying out all components of the Medical Management programs (UM/CM/QM).
      • Monitors adherence to and works with managers/supervisors/those with direct reports to hold staff accountable to the requirements of the ProgenyHealth Quality Management Program, as well as to ensure we are meeting/exceeding all Client-specific requirements for compliance.
      • Participates in development and implementation of Quality Improvement projects.
      • Provides input and ideas for, and plays an active role in, corporate strategic planning.
      • Identifies new opportunities and is attuned to the industry as a whole, to ensure market leadership.
Qualifications:
      • A minimum of 10 years’ experience in a management role with oversight of QM, UM and CM staff required. Prefer experience with managing staff sizes of 300 or more, both onsite and remote.
      • Minimum of five years in a managed care environment at this level of expertise.
      • Experience in managing call center metrics and accountability.
      • Bachelor’s degree required. Master’s degree or higher level of education preferred.
      • Executive presence required, with the ability to lead and engage teams
      • Proven record of success, with a strong understanding of healthcare, care management programs and delivering results which drive customer retention and expansion.
      • Experience in program development and/or health policy development and implementation.
      • Experience in UM/CM/QM management and accreditation guidelines.
      • Must be self-motivated and willing to learn multiple tasks.
      • Must be well organized and able to prioritize tasks.
      • Must have excellent computer skills and be proficient in Microsoft Office
Job Location:
      • Plymouth Meeting, PA


Send resume AND salary history to:
HR Department, ProgenyHealth
Email: jobs@progenyhealth.com
Fax: 484-362-6558

 

 

Utilization Management Associate

Job Description:

The Utilization Management Associate (UMA) will assist the ProgenyHealth UM program by providing administration support to the Utilization Review department. This includes: intake, screening and precertification of appropriate healthcare services. They will also be responsible for assisting the Clinical Care Nurses with clerical tasks associated with discharge planning/utilization review functions. The UMA will report to the Supervisor of Utilization Review.

Job Responsibilities:
      • Monitor Member eligibility
      • Perform outreach calls to hospitals for follow-up clinical information and discharge info
      • Process new admissions: this includes update of patient demographics; create new case in BabyTrax®; document new case in client system; assign Clinical Care nurse
      • Communicate verbally and/or written prior auths based on client specifications
      • Skilled Nursing visits: receive request and complete referral form; document in BabyTrax; create outpatient case and assign to appropriate Clinical Care nurse
      • Receive incoming calls for UM and refer to appropriate staff member
      • Adheres to policies, procedures and regulations to ensure compliance and patient safety.
      • Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements
      • Provides additional support and project work within the various Care Management areas of accountability as needed.
Qualifications:
      • 1 – 3 years of experience in customer service in a healthcare environment.
      • HS diploma or equivalent required. College degree preferred.
      • Insurance/payor experience preferred.
      • Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas as well as interact professionally and effectively with members, clients, and staff from all departments within and outside the company.
      • Problem solving skills with the ability to look for root causes and implementable, workable solutions.
      • Must be proficient at an intermediate to advanced level in Outlook, Excel, PowerPoint, & Word.
      • Must be fluent in English. Proficiency in a second language is highly desirable.
      • Must be self-motivated and willing to learn multiple tasks.
      • Must be well-organized and able to prioritize tasks.
      • Must have commitment to excellence in customer service.
Job Location:
      • Plymouth Meeting, PA


Send resume AND salary history to:
HR Department, ProgenyHealth
Email: jobs@progenyhealth.com
Fax: 484-362-6558

Utilization Management Nurse

Job Description:

Coordinate overall member care, from pre-admission, continued stay (concurrent review) and any outpatient services utilizing a pro-active, evidence-based decision making process that is physician sensitive and attaining quality outcomes for the members. The clinical care nurse serves as a nurse reviewer for admissions, lengths of stay and a facilitator for discharge planning. This position functions as a liaison between the providers, hospitals and health plans. Responsible for the implementation of client-specific contracted polices, managed care policies and must be very knowledgeable about benefits, criteria and guidelines used for reviews. Must be adept at identifying and referring potential quality of care issues to the Medical Director, client and/or appropriate staff.

Job Responsibilities:

      • Initiating the continuum of care process for neonatal admissions.
      • Interacting telephonically and in writing with hospital staff to collect clinical information for newborns in intensive care nurseries in order to facilitate medical necessity determinations.
      • Coordinating discharge planning needs for newborns being discharged from intensive care nurseries.
      • Authorization of all services requiring prior authorization, based upon health plan specific service agreements
      • Review of all services (readmissions and elective procedures) for first year of life
      • Documenting all activities in the electronic medical record.

Job Requirements:

      • Registered Nurse (RN) with a current, unrestricted license in required
      • Three or more years of clinical experience as a Pediatric/NICU nurse or Adult ICU nurse is required.
        • *If clinical experience is *Adult ICU, candidate must have three+ years’ experience working in a health plan OR in a concurrent review or discharge planning role within an acute facility.
      • Experience with InterQual and/MCG preferred.
      • Experience with URAC or NCQA standards preferred
Job Location:
      • Plymouth Meeting, PA


 

Send resume AND salary history to:
HR Department, ProgenyHealth
Email: jobs@progenyhealth.com
Fax: 484-362-6558

Utilization Management Nurse – 100% Telecommute

Job Description:

Clinical care nurses coordinate overall member care, from pre-admission, continued stay (concurrent review) and any outpatient services utilizing a pro-active, evidence-based decision making process that is physician sensitive and attaining quality outcomes for the members. The clinical care nurse serves as a nurse reviewer for admissions, lengths of stay and a facilitator for discharge planning. This position functions as a liaison between the providers, hospitals and health plans. Responsible for the implementation of client-specific contracted polices, managed care policies and must be very knowledgeable about benefits, criteria and guidelines used for reviews. Must be adept at identifying and referring potential quality of care issues to the Medical Director, client and/or appropriate staff.

Job Responsibilities:
      • Initiating the continuum of care process for neonatal admissions.
      • Interacting telephonically and in writing with hospital staff to collect clinical information for newborns in intensive care nurseries in order to facilitate medical necessity determinations.
      • Coordinating discharge planning needs for newborns being discharged from intensive care nurseries.
      • Authorization of all services requiring prior authorization, based upon health plan specific service agreements
      • Review of all services (readmissions and elective procedures) for first year of life
      • Documenting all activities in the electronic medical record.
Qualifications:
      • Registered Nurse (RN) with a current, unrestricted license is required.
      • Three or more years of clinical experience as a NICU nurse is required.
      • Five (5)+ years experience working in a concurrent review or discharge planning role within a health plan or an acute facility is required.
      • Experience with InterQual and/or MCG is required.
      • Experience with URAC or NCQA standards preferred.
      • Data entry skills required.
      • Must be comfortable with and have good computer skills.
      • Excellent communication skills and organizational ability is required.
      • Must be self-motivated and willing to learn multiple tasks. Must be well organized and able to prioritize tasks.
      • Must demonstrate accuracy in spelling and documentation. Ability to perform job functions with autonomy and be a self starter. Must possess excellent interpersonal skills, telephone etiquette and maintain positive communication at all times.
      • Must have commitment to excellence in customer service.

Send resume AND salary history to:
HR Department, ProgenyHealth
Email: jobs@progenyhealth.com
Fax: 484-362-6558

Utilization Management Supervisor

Job Description:

The incumbent will primarily be responsible for managing the Utilization Management nursing staff in the day to day operations of the department. This includes oversight and adjustment of work queues, when needed, to maintain work flow balance; monitoring and implementing adherence to department and company metrics; training of new hires and on-going clinical; and various other responsibilities to support the clinical nursing staff and the company program. The incumbent will also be responsible for assessment of the UM program for opportunities to improve efficiencies and/or improve outcomes.

Reporting to the Director of Utilization Review, the Supervisor will work closely with the management staff and will play a key role in implementing the culture and work environment that promotes and inspires an active, continuous improvement philosophy regarding products and services in line with our company mission statement:

To improve the health outcomes of infants in intensive care nurseries through partnership, care
facilitation, continuous quality improvement and a firm commitment to excellence.

Job Requirements:
      • Registered Nurse (RN) with a current, unrestricted license is required.
      • Two or more years of experience in Managed Care, in a Utilization Review or Case Management role is required.
      • Three or more years’ experience in a supervisory role managing nursing staff.
      • Three or more years of clinical experience as a bedside nurse in NICU/PICU/Peds or other Intensive care unit preferred.
      • Must be available to stay late as needed to manage staff and caseloads.
      • Experience with URAC standards preferred.
      • Must have demonstrated strong problem-solving skills.
      • Must have proven track record of utilizing tact, diplomacy and strategic thinking in addressing issues and changes in company policy, etc.
      • Must be self-motivated and willing to learn multiple tasks.
      • Must be well organized and able to prioritize tasks.
      • Must have good computer skills and be familiar with using Microsoft Office (Word, Outlook etc)
      • Must demonstrate accuracy in spelling and documentation.
      • Must have commitment to excellence in customer service.
Job Location:
    • Plymouth Meeting, PA – for candidates not residing locally, relocation assistance is available