Virginia Premier Health Plan, Inc.

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Manager, Health Services (Medicare Advantage)

Manager, Health Services (Medicare Advantage)

Job Locations 
US-VA-Glen Allen
Job ID 
2017-4221

Job Description

Overview

The Manager, Health Services is responsible for assisting the Sr. Mgr. with program development and providing direct supervision of Virginia Premier Health Services’ staff in their region for daily clinical decisions, monitoring of individual performance and compliance with Virginia Premier policies and procedures. Also responsible for identifying and delivering clinical process improvements for the Medicare Advantage (MAPD) line of business.

Responsibilities

  • Supervises medical management staff designated for the Medicare Advantage (MAPD) program according to Virginia Premier policy and procedures to assure that case management reviews and activities are accurate, consistent, and performed in a timely manner
  • Works with medical management staff to provide guidance and/or intervention in problematic/unusual cases in all office locations.
  • Serves in an advisory capacity for problem solving, reviewing reports being sent to internal and external customers, reviewing problematic cases, and monitor case management activities
  • Maintains resources, keeping information up-to-date
  • Assists in the ongoing development of programs and medical management projects to enhance/expand the medical management department
  • Maintains confidentiality of patient information, and Virginia Premier proprietary operational information
  • Monitors business processes and manages the Virginia Premier MAPD operational processes as defined by the state contract and Virginia Premier model of care
  • Monitors clinical metrics and monthly department dashboards
  • Assists with quality improvement efforts as needed
  • Assists with development of policy, procedure, standard operating procedure, workflow, job aids, training materials for Virginia Premier MAPD population
  • Develops and maintains strong working relationships with both internal and external stakeholders
  • Works with the Senior Leadership team to gain approval for program enhancements
  • Provides training, mentoring and coaching where appropriate
  • Maintains current knowledge of Virginia Premier and Virginia Premier MAPD policies and procedures
  • Participates in community programs (which may occur outside of normal business hours) in collaboration with the MAPD team

Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • Minimum education degree of Bachelors of Science in a health care field
  • License/Certification – Current Registered Nurse licensed to practice nursing in Virginia
  • Certified Case Manager (CCM), preferred

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Patient assessment skills
  • Knowledge of community resources and vendor options and experience in making appropriate referrals
  • Ability to negotiate with providers, vendors and care providers
  • Ability to communicate effectively verbally and in writing
  • PC literate
  • Possess knowledge of ICD-9 and CPT4 coding
  • Ability to travel locally and to other regions throughout the state for training, meetings, etc.

WORK BACKGROUND/EXPERIENCE

  • Case management experience, preferably in a managed care environment
  • Minimum of 2 years of management experience
  • Experience in Medicaid and Medicare managed care
  • Demonstrates excellent verbal and written communications
  • Demonstrates working knowledge of computers and MS office programs
  • Experience working with low income disadvantaged 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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