• Regional Transition Coordinator

    Job Locations US-VA-Charlottesville | US-VA-Bristol | US-VA-Chesapeake | US-VA-Danville | US-VA-Alexandria | US-VA-Roanoke | US-VA-Glen Allen
    Job ID
    2018-4769
  • Overview

    Under the supervision of the Manager, the Regional Transition Coordinator is responsible for managing members who undergo transitions of the following:

    1. Hospitals (acute discharge) to:
      1. Nursing facility (skilled or custodial)
      2. Community with HCBS waiver
      3. Community without HCBS waiver
    2. Hospitals (psychiatric) discharge to:
      1. Nursing facility (skilled or custodial)
      2. Community with HCBS waiver
      3. Community without HCBS waiver
      4. Residential Treatment Facility
    3. HCBS waiver to:
      1. Hospital (acute or psychiatric)
      2. Nursing facility (skilled or custodial)
      3. Residential Treatment Facility
    4. Community without HCBS waiver to:
      1. Hospital (acute or psychiatric)
      2. Nursing facility (skilled or custodial)
      3. Community with HCBS waiver
      4. Residential Treatment Facility
    5. Long-term Institution transition to:
      1. Community with HCBS waiver
      2. Hospital and back to Nursing Facility 

    Unit Description

     

    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

    Participates in discharge planning for Members transitioning from acute institutional settings to lower levels of care, including Long Stay Hospitals, Nursing Facilities, and the community

    • Provides support to care coordinators to maintain Members in the community in lieu of transitioning to institutional settings, as needed.
    • Serves on the ICT for all members who are in transition
    • Facilitates communication and coordination between members of the health care team
    • Provides referrals for brief and immediate crisis intervention (i.e. Adult Protective Services).
    • Educates the member, the family or caregiver, and members of the health care team about treatment options, community resources, insurance benefits, psychosocial concerns, care management , etc., so that timely and informed decisions can be made.
    • Empowers the member to problem solve by exploring options of care, when available, and alternative plans, when necessary, to achieve desired outcomes
    • Strives to promote member self-advocacy and self-determination
    • Acts as an advocate for a member’s health care needs
    • Practices in accordance with applicable local, state and federal laws which govern confidentiality and medical information privacy regulations (HIPAA)

     

    Qualifications

    MINIMUM EDUCATION REQUIREMENTS

    • Bachelor degree in Health or Human Services OR;
    • Registered Nurse licensed to practice in the Commonwealth of Virginia (Bachelor preferred) OR;
    • Licensed Practical Nurse in the Commonwealth of Virginia
    • Certified Case Manager preferred

     

    SPECIAL KNOWLEDGE AND OR SKILLS

    • Excellent oral and written communication skills
    • PC literate with working knowledge of Microsoft Office and various computer software programs
    • Working knowledge of community resource options, and experience in making appropriate referrals
    • Strong decision making skills and ability to handle multiple priorities
    • Knowledge of case management and transitions/discharge planning
    • Knowledge of home and community based service waivers needed
    • Some local travel may be necessary 

     

    ELIGIBILITY REQUIREMENTS

    • Must have valid Driver's license with positive points on DMV record.
    • Willing and able to conform to pre-employment background check

     

    PHYSICAL REQUIREMENTS

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

     

    About Us

     

    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.  

     

    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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