Virginia Premier Health Plan is a managed care organization owned by the Virginia Commonwealth University Medical Center, meets the needs of underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable healthcare.
We are committed to recruiting, employing and retaining individuals who will live our philosophy of providing the best service to our members, providers, vendors and internal customers.
With locations all across the state of Virginia, we are proud of our track record of developing and promoting our employees. We encourage our employees to take advantage of our multiple ways to continue their education, including our generous Tuition Reimbursement Program. We are committed to the continuous growth and development of our most valuable asset, our employees.
We hope you will take the time to explore the opportunities to join our team. Our commitment to our employees continues to bring us great recognition as a company that truly makes a difference in the community.
We are an organization that is continuously growing. Come grow with us.
POSITION OVERVIEW
Responsible for leadership and management of case management staff, including operational decisions, daily clinical decisions, process improvement, staff development, and compliance with VPHP policies and procedures.
POSITION DUTIES AND RESPONSIBILITIES
•Supervises Case/Care Management (CM), Social Work (SW) and other support staff according to VPHP’s policy and procedures to assure that CM reviews and SW activities are accurate, consistent, and performed in a timely manner.
•Assists with the development of CM and SW staff onboarding and training programs.
•Coaches staff and supports healthy team dynamics.
•Serves in an advisory capacity for problem solving, reviewing reports being sent to internal and external customers, reviewing problematic cases, and monitor case management activities.
•Review specialized reports to identify trends and opportunities for improvement to enhance relationships with the provider network and service to members.
•Ensure requirements for auditing CM decisions, documentation and quality are being met.
•Assists Director of CM with ongoing Quality Improvement Program by assisting with various quality review tasks such as collecting and analyzing data as outlined in the program.
•Assists in the ongoing development of programs and medical management projects to enhance/expand the medical management department.
•Maintains confidentiality of patient information, and VPHP proprietary operational information.
•Maintains current knowledge of VPHP policies and procedures.
•Participates in continuing education activities as appropriate.
•Participates in community programs (which may occur outside of normal business hours).
•This position provides services and demonstrates the knowledge and ability to meet the specific needs of the following age groups: All Infant Adult Child Geriatric
•Other duties as assigned.
SPECIAL KNOWLEDGE AND/OR SKILLS
•Excellent problem solving skills
•Patient assessment skills
•Knowledge of community resources and vendor options, and experience in making appropriate referrals
•Ability to negotiate with providers and vendors
•Demonstrates excellent verbal and written communications
•Demonstrates working knowledge of computers and word processing programs
•Ability to build and support successful work teams
•Possess knowledge of ICD-9 and CPT4 coding
•Knowledge of Six Sigma Lean methodology or other Performance Improvement methodology
WORK BACKGROUND/EXPERIENCE
•Case management experience, preferably in a managed care environment
•Management experience
•Experience in clinical nursing
•Experience working with low income disadvantaged populations.
REQUIREMENTS:
•Registered Nurse licensed to practice nursing in Virginia
•Bachelor’s degree
•Certified Case Manager (CCM), preferred
•Management experience
PHYSICAL REQUIREMENTS
Physical health sufficient to meet the ergonomic standards and demands of the position.
Qualified candidates please apply online at https://www.appone.com/MainInfoReq.asp?R_ID=942449
EOE