• Case Manager III Team Lead

    Job Locations US-VA-Roanoke
    Job ID
    2018-4912
  • 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 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

    • Conducts a comprehensive assessment of the member’s health and psychosocial needs, including health literacy status and deficits, and develops a case management plan collaboratively with the member and family or caregiver.
    • Plans with the member, family or caregiver, the PCP/provider, other health care providers, and the community to maximize health care responses, quality and cost-effective outcomes
    • Facilitates communication and coordination between members of the health care team, involving the member in the decision-making process in order to minimize fragmentation in the services.
    • Educates the member, the family or caregiver, and members of the health care team about treatment options, community resources, insurance benefits, psychosocial concerns, case 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
    • Encourages the appropriate use of health care services and strives to improve quality of care and maintain cost effectiveness on a case–by-case basis.
    • Assists the member in the safe transitioning of care to the next most appropriate level
    • Strives to promote member self-advocacy and self-determination
    • 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
    • Practices in accordance with applicable local, state and federal laws which govern confidentiality and medical information privacy regulations (HIPAA)
    • Interviews members telephonically, or face-to-face in the physician’s office, home visits or in other facilities to provide initial and ongoing case management services.
    • Conducts regular discussions and updates with the member’s primary care physicians, other providers and members of the multidisciplinary health service team
    • Manages Private Duty Nursing cases as assigned
    • Spends one day per week minimum meeting face-to-face with members

    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 subject matter expert for the team with regards to any questions or help support they may need, such as:

      • Questions about appropriateness of reviews
      • Identifying member resources and case management solutions
      • 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
    • Monitors CM III Field Visit Log and PDN Spreadsheet
    • 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 II 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
    • Minimum of three years of clinical experience
    • 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 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
    • Regular local travel will be required

    WORK BACKGROUND/EXPERIENCE

    • Minimum of three (3) years clinical experience and/or current managed care experience
    • Experience working with low income and disadvantage populations
    • Utilization management experience and knowledge of community resources preferred

    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!

    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.