• Manager, Case Management

    Job Locations US-VA-Bristol
    Job ID
    2018-4893
  • About Us

    Don’t just find a job, find your WHY at a purpose-driven organization; discover a career at Virginia Premier.
    By blending quality benefits, affiliating with the world-renowned VCU Health System and offering career-advancing development programs, we allow our employees to focus on the meaningful work of improving and saving the lives of more than 200,000 people throughout the state of Virginia.
     
    At Virginia Premier, we are building an industry leading health care organization through dedicated teams that have heart, provide top-notch quality member services and embrace our mission of inspiring healthy living within the communities we serve. Our vision is to connect people to innovation, quality and affordable health care for all phases of life.
     
    If this sounds like you, read on!

    Overview

    Responsible for leadership and management of case management staff, including operational decisions, daily clinical decisions, process improvement, staff development, and compliance with Virginia Premier policies and procedures.

     

    Responsibilities

    • Supervises Case/Care Management (CM), Social Work (SW) and other support staff according to Virginia Premier policy and procedures to assure that CM reviews and SW activities are accurate, consistent, and performed in a timely manner.
    • Assists with the development of CM and SW staff onboarding and training programs.
    • Coaches staff and supports healthy team dynamics.
    • 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.
    • Review specialized reports to identify trends and opportunities for improvement to enhance relationships with the provider network and service to members.
    • Ensure requirements for auditing CM decisions, documentation and quality are being met.
    • Assists Director of CM with ongoing Quality Improvement Program by assisting with various quality review tasks such as collecting and analyzing data as outlined in the program.
    • 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.
    • Maintains current knowledge of Virginia Premier policies and procedures.
    • Participates in continuing education activities as appropriate.
    • Participates in community programs (which may occur outside of normal business hours).
    • This position provides services and demonstrates the knowledge and ability to meet the specific needs of all age groups from infant to geriatric

    Qualifications

     EDUCATION REQUIREMENTS:

    • Registered Nurse licensed to practice nursing in Virginia
    • Bachelor’s degree preferred
    • Certified Case Manager (CCM), preferred
    SPECIAL KNOWLEDGE AND/OR SKILLS
    • Excellent problem solving skills
    • Patient assessment skills
    • Knowledge of Medicare and Medicaid regulations
    • Knowledge of community resources and vendor options, and experience in making appropriate referrals
    • Knowledge of NCQA and HEDIS
    • Ability to negotiate with providers and vendors
    • Demonstrates excellent verbal and written communications
    • Demonstrates proficiency in Microsoft Office applications
    • Ability to build and support successful work teams
    • Knowledge of Six Sigma Lean methodology or other Performance Improvement methodology

    WORK BACKGROUND/EXPERIENCE

    • Case management experience, preferably in a managed care environment
    • At least one year of management experience
    • Minimum of 2 years’ experience in clinical nursing
    • Experience working with low-income disadvantaged populations.

    PHYSICAL REQUIREMENTS

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

     

    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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