• Case Manager II Team Lead

    Job Locations US-VA-Glen Allen
    Job ID
    2018-4790
  • Overview

    Responsible for the timely coordination of quality health care services to meet the member’s specific health care needs in a cost-effective manner to promote positive outcomes. Performs care management for members with complex and chronic care needs by assessing, implementing, coordinating, monitoring, and evaluating plan of care designed to optimize member health care across the continuum and ensuring member access to services appropriate to their health needs.

    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

     

    • Create case in VITAL for all members identified for case management
    • Obtain verbal consent from member for participation in the case management program
    • Assessment
      • Conduct a comprehensive assessment on each member that includes clinical and mental status, clinical history, ADL’s cultural and linguistic needs, and life planning
      • Assess resource utilization and cost management
    • Planning
      • Develop individualized plan of care with input from member/family that includes long and short-term goals
      • Collaborate with PCP and other members of the health care team in plan of care
      • Identify resources to be utilized, including the appropriate level of care
    • Problem identification
      • Identify problems that require case management intervention
      • Identify barriers to care such as member’s lack of understanding, motivation, financial, transportation needs and over/under utilization of services
    • Monitoring
      • Schedule follow up and communication with member to monitor the quality of care to determine if the plan of care is being achieved
      • Coordinate and modify resources and services needed to evaluate the effectiveness of the plan of care
    • Evaluation
      • Assess progress against case management plan and goals and modify as needed
    • Outcomes
      • Assists in data collection to evaluate the access, cost and quality of care provided
    • Practices in accordance with applicable local, state and federal laws which govern confidentiality and medical information privacy regulations (HIPAA)
    • Knowledgeable of accreditation and regulatory standards
    • Seeks appropriate resources and consultation to help formulate ethical decisions
    • Acts as an advocate for a member’s health care needs
    • Participates in VPHP’s ongoing quality improvement process
    • Participates in continuing educational activities as appropriate
    • Participates in case management rounds/meetings
    • Other job duties as neede

    Additional Team Lead Responsibilities:

    • Daily review of staffing, coverage issues, upcoming meetings, and any clinical/operational concerns.
    • Provide coverage assignments in the absence of team members and communicate to Managers
    • Inform Manager of any changes in staffing throughout the day.
    • Act as a resource person for the team with regards to any questions or help they may need, such as:
      • Questions about appropriateness of reviews
      • Identifying member resources
      • Questions about determining risk and using the Medical Intelligence program
      • Questions about policies, care model processes, and SOPs
      • Helping team identify members for case management rounds
    • Coordinate Case Management Rounds
    • Assist Managers with training/orientation needs.
    • Assist with SOPs and policy development as needed.
    • Participate in projects/committees as needed.
    • Cover for Team Leader III in his/her absence.
    • Solicit items for the monthly All Levels Case Management Meeting and send to Manager

     

    Qualifications

    MINIMUM REQUIREMENTS

    • Registered Nurse licensed in Virginia
    • Bachelor’s degree in related field, preferred
    • Certified Case Manager, preferred

    SPECIAL KNOWLEDGE AND/OR SKILLS

    • Patient care evaluation skills and the ability to communicate well (written and verbal) with all levels of management, medical staff and employees.
    • Computer literate with working knowledge of Microsoft Office and various computer software programs
    • Working knowledge of resource options, and experience in making appropriate referrals
    • Strong decision making skills, ability to handle multiple priorities

    WORK BACKGROUND/EXPERIENCE

    • Minimum of three (3) years clinical experience and/or current managed care experience
    • Experience working with low income and disadvantage 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!

    Options

    Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
    Share on your newsfeed

    Need help finding the right job?

    We can recommend jobs specifically for you! Click here to get started.