Long Term Services and Support Care Coordinators provide primary care management to members receiving home and community based waivers. Care management focuses on high risk Medicaid and/or dual-eligible members (adults and children) and utilizes face-to-face visits to conduct assessments and telephonic support for ongoing care coordination needs. This position works intimately with the member and their interdisciplinary care team to enhance quality, improve member outcomes, and encourage appropriate utilization.
Medical Management educates members and empowers them to become active participants in their coordinated health care plans. This team of knowledgeable professionals in their field provide services to include Utilization Review, Medical Outreach, Case Management, Disease Management, Credentialing, Social Work as well as Grievance and Appeals
POSITION DUTIES AND RESPONSIBILITIES
Conducts time-sensitive, face-to-face initial comprehensive assessment of the member’s medical and behavioral health, psychosocial needs, functional status, social history, including health literacy status and deficits, and develops an individualized care plan (ICP) collaboratively with the member, family, caregiver, PCP, and participants of the member’s interdisciplinary care team (ICT).
Conducts triggering assessments and updates to the ICP with the member, family or caregiver, the PCP/provider, other health care providers, and the community to maximize health care responses, quality and cost-effective outcomes.
Collaborates with UR nurse to manage length of stay based upon medical necessity, community supports, and member’s specific social situation
Provides referrals for brief and immediate crisis intervention (i.e. Adult Protective Services).
Educates the member, the family or caregiver, and members of the health care team about treatment options, community resources, insurance benefits, psychosocial concerns, care management , etc., so that timely and informed decisions can be made.
Assists the member and their family/caregiver in navigating the health care system
Encourages the member to be actively involved in the health care decision-making process
Empowers the member to problem solve by exploring options of care, when available, and alternative plans, when necessary, to achieve desired outcomes.
Encourages the appropriate use of health care services and strives to improve the quality of care and maintain cost effectiveness on a case–by-case basis.
Collaborates with the transition coordinator to ensure member’s needs are met when undergoing transitions.
Provides referrals to health-related services such as disease management and health education.
Assists members in crisis.
Strives to promote member self-advocacy and self-determination.
Acts as an advocate for a member’s health care needs.
Participates in VPHP’s ongoing quality improvement process.
Participates in continuing educational activities as appropriate
Participates in care management rounds/meetings.
Practices in accordance with applicable local, state and federal laws which govern confidentiality and medical information privacy regulations (HIPAA)
Leads and conducts regular communications with the member’s chosen ICT
Provides oversight and maintenance of the member’s ICP
Collaborates with LTSS Care Coordinator to ensure assessments and ICPs capture all required elements as outlined in the contract
Ensures approval for all assessments and ICPs is received from the LTSS Care Coordinator, Manager, or Supervisor
Other duties as assigned
MINIMUM EDUCATION REQUIREMENTS
SPECIAL KNOWLEDGE AND/OR SKILLS
Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs. Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia.
We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.
Our mission is to inspire healthy living within the communities we serve!