Virginia Premier Health Plan, Inc.

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Disease Management Coordinator - RN

Disease Management Coordinator - RN

Job Locations 
US-VA-Glen Allen
Job ID 
2017-4167

Job Description

Overview

The Disease Management Coordinator is responsible for managing a system of health care interventions to specific patient populations. The Disease Management Coordinator will be responsible for the coordination of services that will promote positive health outcomes, emphasize prevention of exacerbations and complications, teach patient self-management skills and identify patients appropriate for disease management.

Responsibilities

  • Early identification of at-risk members for disease management intervention.
  • Provide disease management services, mostly telephonic, according to VPHP’s policies and procedures to assess the member’s current health and psycho-social status, resource utilization and past and present treatment plans and services.
  • Initiate contact with member, family, and health care providers to coordinate services.
  • Conducts a comprehensive assessment of the member’s health and psychosocial needs, including health literacy status and deficits.
  • Develop, coordinate and implement Disease Management Plan. Maintains records documenting the plan of care
  • Continuously monitor, reassess and re-evaluate that the treatment plan remains appropriate.
  • Identify gaps or barriers preventing the member from following through with a recommended treatment plan consistent with optimal care for specified disease condition
  • Provide education to assist/teach self -management skills
  • Provides information on network access and identifies and implements interventions and resources that address and close gaps in care
  • Close cases according to the defined case closure procedure
  • Assists in analyzing and reviewing data to monitor performance outcomes
  • Researches, evaluates and recommends community resources to meet the non-medical needs of members
  • Maintains disease management resources, keeping information current
  • Plan disease management team conference, and other meetings as needed to discuss care options.
  • Acts as a liaison to promote an effective working relationship with providers (including vendors). The disease management coordinator shall serve as an informed resource on Premier’s policies and benefits to all providers 
  • Participates in continuing educational activities as appropriate
  • Participates in the orientation and training of case management staff
  • Participates in Premier’s ongoing quality improvement process
  • Assists in the ongoing development of programs and projects to enhance/expand disease management resources to meet member needs
  • Maintains confidentiality of member information and Premier’s proprietary operational information

Qualifications

 

MINIMUM EDUCATION REQUIREMENTS

  • Registered Nurse licensed in Virginia
  • Bachelors of Science degree in Nursing (BSN) preferred
  • Certified Case Manager (CCM) preferred

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Patient care evaluation skills and the ability to communicate well (written and verbal) with all levels of management, medical staff and employee
  • PC literate with working knowledge of Microsoft Word, Excel spreadsheet programs and various computer software programs
  • Possess a working knowledge of ICD-9 and CPT-4 coding

 

WORK BACKGROUND/EXPERIENCE 

  • Minimum of 2 years of clinical experience working with the elderly, disabled, low income/disadvantaged, and/or vulnerable subpopulations
  • Experience in care management, assessments, long-term member/patient care management or community based resource delivery
  • Knowledge of resource options, and experience in making appropriate referrals
  • Experience with Care Coordination and working with Interdisciplinary Care Teams preferred

 

PHYSICAL REQUIREMENTS

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

 

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!

 

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. 

 

Equal Opportunity Employer 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.

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