• Case Manager II

    Job Locations US-VA-Chesapeake
    Job ID
    2018-5017
  • 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 plans 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 Care Management Documentation system for all members identified for case management
    • Obtain verbal consent from member for participation in the case management program
    • 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
    • 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
    • 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
    • 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
    • Assess progress against case management plan and goals and modify as needed
    • 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)

    • Seeks appropriate resources and consultation to help formulate ethical decisions
    • Acts as an advocate for a member’s health care needs

    Qualifications

    MINIMUM EDUCATION REQUIREMENTS

    • Registered Nurse (RN) licensed in Virginia required
    • 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
    • Experience working with low income and disadvantage populations
    • Minimum of one (1) year recent case management and managed care experience; Two (2) or more years preferred within the last 3-5 years

    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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