• Case Manager III

    Job Locations US-VA-Alexandria | US-VA-Winchester
    Job ID
    2018-5288
  • 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

    Care Management focuses on high risk Medicaid/Medicare members utilizing face to face nurse case manager visits integrated with a multidisciplinary team and the member’s primary care physicians in an effort to enhance quality, improve member outcomes and encourage appropriate utilization.

     

    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 Virginia Premier'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, 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

    Qualifications

    MINIMUM EDUCATION REQUIREMENTS

    • Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW)
    • Bachelors of Science 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.
    • PC 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
    • Driving record must reflect positive points balance (min of +1)

    WORK BACKGROUND/EXPERIENCE

    • Minimum of 3 years clinical experience
    • Experience working with low income and disadvantage populations
    • Home Health 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!

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