Virginia Premier Health Plan, Inc.

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Supervisor, Care Coordination

Supervisor, Care Coordination

Job Locations 
US-VA-Charlottesville
Job ID 
2017-4165

Job Description

Overview

The Supervisor, Care Coordination is responsible for supervising MLTSS care coordination staff, providing daily oversight of all care coordination activities performed by staff, and supporting leadership in MLTSS program enhancements.   This positoin is part of the Medical Management team and is located in the Charlottesville, VA.

 

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

 

Responsibilities

  • Supervises day-to-day model of care (MOC) activities performed by staff for the MLTSS program including assessments, individualized care plans, interdisciplinary care team meetings, transitions, and care coordination.
  • Maintains appropriate staffing levels and assignments to ensure excellent customer service and meet regulatory timeframes.
  • Works with care coordination staff to provide guidance and/or intervention in problematic/unusual cases
  • Assists with onboarding new staff and ongoing mentoring/coaching of care coordinator staff
  • Serves in an advisory capacity for problem solving, reviewing reports being sent to internal and external customers, reviewing problematic cases, and monitor medical management activities in collaboration with the manager
  • Maintains resources, keeping information up-to-date
  • Supports Manager in ongoing quality improvement initiatives by assisting with various quality review tasks such as collecting and analyzing data as outlined in the program
  • Participates in assigned VPHP meetings to educate providers and/or members (which may occur outside of normal business hours)
  • Provides Manager with documentation on individual team members’ performance on a regular basis
  • Performs annual/interim appraisals of care coordinator staff as assigned
  • Collaborates with the Manager and Human Resources team develop, implement, and monitor corrective action plans for staff as appropriate
  • Assists in the ongoing development of programs and care coordination projects to enhance/expand the department

Qualifications

EDUCATION/CERTIFICATION REQUIREMENTS:

  • Registered Nurse licensed to practice nursing in Virginia; or
  • Licensed Clinical Social Worker; or
  • Licensed Mental Health Professional
  • Certified Case Manager (CCM) is a plus

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Strong oral and written communication skills
  • Knowledge of community resources and vendor options and experience in making appropriate referrals
  • Possess knowledge of Medicare and Medicaid programs
  • Ability to communicate effectively with individuals who have complex medical and/or behavioral health needs
  • PC literate with working knowledge of Microsoft Office applications 

WORK BACKGROUND/EXPERIENCE

  • Minimum of 1 year working experience in a long term care, home health, behavioral health, or Medicaid managed care setting
  • Prior supervisory experience is preferred
  • Experience working with low-income, disadvantaged, disabled, elderly, and vulnerable populations

PHYSICAL REQUIREMENTS

  • Physical health sufficient to meet the ergonomic standards and demands of the position

About Us

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.  

 

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

 

Our mission is to inspire healthy living within the communities we serve!

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