• Operations Coordinator

    Job Locations US-VA-Glen Allen
    Job ID
    2018-5183
  • 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 of the Supervisor, this position is responsible for providing operational support of MLTSS clinical processes in collaboration with the care coordination team.  

     

    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

    • Creates MCO80 and DMAS 225 forms
    • Reviews reports / requests / documentation for information concerning LOC changes
    • Contacts providers for LOC change information
    • Processes LOC change forms to include data entry, faxing and notating in the charting system
    • Ensures LOC change forms are stored on the shared drive
    • Collaborates with the Supervisor to correct LOC change forms and LOCERI submissions
    • Enters data on vendor referral forms
    • Acts as point of contact for staff who need to access the DMAS portal for LOC change forms and LOCERI
    • Receives daily, monthly and other LOCERI lists from DMAS, creates spreadsheets, sorts and assigns lists and disseminates to appropriate staff
    • Tracks and monitors completion of LOCERI within expected timeframes
    • Supports ongoing education efforts for LOC change forms and LOCERI processes
    • Maintains resources related to MLTSS operational processes, keeping information up-to-date
    • Supports Supervisor in ongoing quality improvement initiatives through collecting and analyzing data as outlined in the program
    • Participates in assigned VPHP meetings with key internal and external stakeholders
    • Maintains confidentiality of member information and VPHP proprietary operational information
    • Maintains current knowledge of VPHP policies and procedures
    • Participates in continuing education activities as appropriate
    • Other duties as assigned

    Qualifications

     

    EDUCATION/CERTIFICATION REQUIREMENTS:

    • Associate’s degree preferred or equivalent work experience

    SPECIAL KNOWLEDGE AND/OR SKILLS

    • Strong oral and written communication skills
    • Proficient knowledge of Microsoft Office applications
    • Ability to work in a team environment
    • Strong typing skills

    WORK BACKGROUND/EXPERIENCE

    • Minimum of 1 year working experience in a medical setting preferably long term care, home health, or behavioral health
    • Knowledgeable of Medicaid waiver services
    • Experience working with low-income, disadvantaged, disabled, elderly, and vulnerable 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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