• Outreach Patient Care Coordinator

    Job Locations US-VA-Alexandria
    Job ID
    2018-4914
  • 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

    Under the direction/supervision of the case manager responsible for coordination of medical services including intake, screening and referrals to VPHP Medical Management programs. Responsible for responding to either inbound inquires or outreach calls to the members and providers. 

     

    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

    • Answers calls routed through the hunt group to ensure that established call standards are met
    • Completes HRAs on all community well members and send requests to CM for follow up
    • Contacts members after discharge, ED visit, or call into Nurse Advice line
    • Assists member/caregiver in making follow up appointment with providers
    • Assists in arranging transportation services
    • Assigns and closes cases as directed by TL or designee
    • Educates the member about VPCC policies, programs and services when contact results in questions, concerns or identified learning needs
    • Provides the member with information on how to access preventive and health maintenance services while identifying barriers
    • Provides the member with resource information based on the recommendations from the case manager
    • Coordinates assignment for case managers to facilitate timely member evaluation
    • Refers issues to Case Manager as soon as identified
    • Provides administrative support for case managers include mailing letters/ educational materials, updating member demographics, faxing documents
    • Maintains knowledge of care coordination and case management concepts
    • Ensures that service authorizations are in place for members as requested by provider and escalating to CM as needed
    • Supports clinical staff to ensure the member needs are being met and expectations of quality services are being exceeded
    • Coordinates and schedules ICT meetings between members, providers, and CM
    • Performs document reconciliation from vendors
    • Performs vendor file attachments
    • Enters assessments from vendors into VITAL
    • Manages incoming faxes from server
    • Performs routine follow up phone calls to members to identify issues with medications, appointments, and transportation (maintenance)
    • Performs follow up phone calls to providers to ensure member kept appointment 

    Qualifications

     

    MINIMUM EDUCATION REQUIREMENTS

    • Associate Degree required (or equivalent experience)
    • Medical terminology preferred 

    SPECIAL KNOWLEDGE AND/OR SKILLS

    • PC literate with working knowledge of Microsoft Office and various computer software programs
    • Strong decision making skills, ability to handle multiple priorities
    • Ability to interact with all relevant components of the health care system
    • Self starter with ability to handle multiple tasks at one time
    • Strong decision making skills
    • Appreciation of cultural diversity and sensitivity towards target population 

    WORK BACKGROUND/EXPERIENCE

    • Minimum of 2 years working in Health Services field
    • 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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