Complex Care Coordinators provide primary care management to members who have complex medical and/or behavioral health needs and are considered part of the Vulnerable Subpopulation [including members with significant mental illness and members with waivers for intellectual disability (ID), developmental disability (IFDDS), and/or requiring day support (DS). The Care coordinators focus on high risk Medicaid and/or dual-eligible members (adults and children) who are at risk for higher utilization of services, readmissions, and/or transitions. This role is mostly telephonic, but may involve some face-to-face interactions with the member to provide the support needed for ongoing care coordination to enhance quality, improve member outcomes, and encourage appropriate utilization of health services.
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
POSITION DUTIES AND RESPONSIBILITIES
MINIMUM EDUCATION REQUIREMENTS
SPECIAL KNOWLEDGE AND/OR SKILLS
Virginia Premier 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!