Virginia Premier Health Plan, Inc.

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Medical Outreach Representative

Medical Outreach Representative

Job Locations 
US-VA-Lynchburg
Job ID 
2017-4171

Job Description

Overview

The Medical Outreach Representative will perform outreach responsibilities in the community for identified Medicaid and Medicare members.

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

  • Provides medical outreach services through face to face contacts during home visits for members identified as candidates for outreach
  • Interacts with members through community visits, telephone contact, and/or written communication.
  • Conducts home visits and may spend up to 80-90 percent of time out in the field
  • Manages Healthy Heartbeat Prenatal Program according to established guidelines
  • Coordinates baby shower events in their service area
  • Follows program guidelines to meet corporate requirements and deadlines
  • Conducts a variety of health assessments and screens members about their health and need for services (Health Risk Assessments)
  • Educates the member about their benefits, how to access services and programs and overall plan usage
  • Works with members to empower them to seek medical care when needed, and to become an active participant in their health care
  • Completes indicated screening tool(s), and return to the case manager for appropriate action
  • Provides members with Health Education Department materials relevant to their particular illness, or on preventive health issues, as recommended by the Health Educator
  • Acts as a liaison between the member and care management teams
  • Maintains caseload and meets productivity and quality standards
  • Provides members with resource information based on the recommendations from the Case Manager/Care Manager
  • Assists the members in accessing community resources that will contribute to their optimal well-being
  • Works with members to include but not limited to men, women, children, pregnant women, elderly, disabled, substance abuse and those with mental health needs
  • This position provides services and demonstrates the knowledge and ability to meet the specific needs of the following age groups to include infant, child, adult and geriatric
  • Occasional overnight travel (trainings and team meetings)
  • Other duties as assigned

Qualifications

 

MINIMUM EDUCATION REQUIREMENTS

  • High school graduate; Bachelor’s degree preferred.

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Good organizational skills
  • PC literate with working knowledge of Microsoft Office
  • Ability to communicate effectively verbally and in writing
  • Strong interpersonal skills
  • Basic familiarity with community resources related to health/social issues
  • Capacity to understand general information relevant to certain health conditions
  • Comfortable discussing general health issues with individuals

WORK BACKGROUND/EXPERIENCE

  • Community outreach/home visits
  • Customer service/sales member services
  • Medical/technical experience an added plus
  • Experience working with members in inpatient, outpatient, home and/or community settings
  • Other related experience

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.  

 

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

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