• Chronic Care Management Nurse

    Job Locations US-VA-Glen Allen
    Job ID
    2018-4900
  • 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 managing a system of health care interventions to specific patient populations. The Chronic Care Management Nurse will be responsible for the coordination of services that will promote positive health outcomes, emphasize prevention of exacerbations and complications, teach patient self-management skills and identify patients appropriate for chronic condition management.

     

    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

    • Early identification of at-risk members for Chronic Care Management Nurse intervention.
    • Provides chronic condition management services, mostly telephonic, according to VPHP’s policies and procedures to assess the member’s current health and psycho-social status, resource utilization and past and present treatment plans and services.
    • Initiate contact with member, family, and health care providers to coordinate services.
    • Conducts a comprehensive assessment of the member’s health and psychosocial needs, including health literacy status and deficits.
    • Develop, coordinate and implement Chronic Care Management Plan. Maintains records documenting the plan of care
    • Continuously monitor, reassess and re-evaluate that the treatment plan remains appropriate.
    • Identify gaps or barriers preventing the member from following through with a recommended treatment plan consistent with optimal care for specified condition
    • Provide education to assist/teach self -management skills
    • Provides information on network access and identifies and implements interventions and resources that address and close gaps in care
    • Close cases according to the defined case closure procedure
    • Assists in analyzing and reviewing data to monitor performance outcomes
    • Researches, evaluates and recommends community resources to meet the non-medical needs of members
    • Maintains Chronic Care Management Nurse resources, keeping information current
    • Plan Chronic Care Management Nurse team conference, and other meetings as needed to discuss care options.
    • Acts as a liaison to promote an effective working relationship with providers (including vendors).  The Chronic Care Management Nurse shall serve as an informed resource on Premier’s policies and benefits to all providers

    Qualifications

    MINIMUM EDUCATION REQUIREMENTS

    • Registered Nurse licensed in Virginia
    • Bachelors of Science degree in Nursing (BSN) 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 employee
    • PC literate with working knowledge of Microsoft Word, Excel spreadsheet programs and various computer software programs
    • Working knowledge of resource options, and experience in making appropriate referrals
    • Possess a working knowledge of ICD-9 and CPT-4 coding

    WORK BACKGROUND/EXPERIENCE

    • Current clinical experience and/or management 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.

    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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