Virginia Premier Health Plan, Inc.

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HEDIS & Provider Engagement Team Lead

HEDIS & Provider Engagement Team Lead

Job Locations 
US-VA-Glen Allen
Job ID 
2017-4198

Job Description

Overview

The Population Health Outcomes Provider Engagement Team Lead will support the Sr. Manager and will manage the scheduling and auditing of both the HEDIS nurses and the Provider Engagement Coordinators.  The Team Lead will manage the HEDIS Training activities, participate in the over read process and audit process related to HEDIS, assist nurses with the admin database process, EMR records and the notification log to the State and other State or Federal entities for Provider Engagement activities.  The Team Lead will ensure coverage for all events in the provider offices and serve as back up when Provider Engagement Coordinators are out of the office. The Team Lead will ensure timely collection of medical records after each provider wellness event, which supports the HEDIS year-long data collection process. This position will lead the team for all HEDIS and Provider Engagement activities spanning Medicaid, Medicare and LTSS.

 

Medical Management

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

  • Follows the direction of the Sr. Manager, HEDIS Outcomes and Member Engagement in the implementation of wellness days in provider offices
  • Coordinate with Provider Relations identify providers for quality engagement and to conduct Virginia Premier Wellness Days at key provider offices to close care gaps
  • Coordinate with Health Education to reach out to members telephonically to schedule them for appointments and assist with setting up transportation, when needed
  • Ensure the collection of medical records after each Provider Engagement Event and ensure the loading of those records into the HEDIS administrative database year-long
  • Participate in the Member Advisory and Provider Advisory Meetings as needed
  • Ensure that mailers are sent at least 30 days prior to the Wellness Day events
  • Manage the accuracy, completeness and notifications to the State (or other entities) of all events
  • Audit each Provider Engagement Rep, at least quarterly, to ensure processes are being followed and member care gap goals are being met
  • Training of the HEDIS Temps and the Provider Engagement Coordinators
  • Ensures that all documentation requirements are met per the guidance of the Manager and/or Director
  • Complies with Plan personnel policies and procedures
  • Development and maintain the departmental manuals, policies and procedures in accordance with Virginia Premier Health Plan quality improvement guidelines
  • Good Driving Record Required

Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • RN Associate Degree required; BS or BA highly preferred

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Analytical skills – proficient using Microsoft Office including Microsoft Excel
  • Openly and actively communicates information and takes initiative to communicate extensively
  • Ability to handle difficult situations diplomatically
  • Effective interpersonal skills, collaboration, and listening skills
  • Ability to build strong relationships within and outside the health plan
  • Strong strategic and business acumen and well grounded in healthcare delivery systems
  • Negotiation skills 

WORK BACKGROUND/EXPERIENCE

  • Previous experience in a member and/or provider engagement role
  • Medicare/Medicaid experience / knowledge highly preferred

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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