Virginia Premier Health Plan LTSS Care Coordinator in Charlottesville, Virginia

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 supervision of the Manager, LTSS Care Coordinators provide primary care management to members receiving home and community based waivers. Care management focuses on high risk Medicaid and/or dual-eligible members (adults and children) and utilizes face-to-face visits to conduct assessments and telephonic support for ongoing care coordination needs. This position works intimately with the member and their interdisciplinary care team 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

  • Provides primary care management of members who receive long term supports and services such as the Elderly and Disabled with Consumer Direction (EDCD), Technology Assisted, and Nursing Facility waivers

  • Conducts time-sensitive, face-to-face initial comprehensive assessment of the member’s medical and behavioral health, psychosocial needs, functional status, social history, including health literacy status and deficits, and develops an individualized care plan (ICP) collaboratively with the member, family, caregiver, PCP, and participants of the member’s interdisciplinary care team (ICT).

  • Conducts triggering assessments and updates to the ICP 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 careTeam

  • Performs secondary review of service requests for residential treatment, substance abuse day treatment, and intensive outpatient treatment.

  • Collaborates with UR nurse to manage length of stay based upon medical necessity, community supports, and member’s specific social situation.

  • Provides referrals for brief and immediate crisis intervention (i.e. Adult Protective Services).

  • Educates the member, the family or caregiver, and members of the health care team about treatment options, community resources, insurance benefits, psychosocial concerns, care management , etc., so that timely and informed decisions can be made.

  • Assists the member and their family/caregiver in navigating the health care system

  • Encourages the member to be actively involved in the health care decision-making process

  • 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 the quality of care and maintain cost effectiveness on a case–by-case basis.

  • Collaborates with the transition coordinator to ensure member’s needs are met when undergoing transitions

  • Provides referrals to health-related services such as disease management and health education

  • Assists members in crisis

  • 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 care management rounds/meetings

  • Practices in accordance with applicable local, state and federal laws which govern confidentiality and medical information privacy regulations (HIPAA)

  • Leads and conducts regular communications with the member’s chosen ICT

  • Provides oversight and maintenance of the member’s ICP

  • Reviews and provides additional guidance (if needed) for all member assessments and ICPs developed by non-licensed staff such as LTSS Care Specialists, CCC 1, and ICC 1

  • Other duties as assigned

Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • Registered Nurse licensed to practice in the Commonwealth of Virginia OR

  • LCSW

  • Certified Case Manager preferred

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Excellent 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

  • Knowledge of case management essentials

  • Regular local travel will be required

WORK BACKGROUND/EXPERIENCE

  • Minimum of 2 years clinical experience working with elderly, disabled, low income/disadvantaged, and vulnerable subpopulations

  • Home Health experience and knowledge of community resources preferred

  • Prior experience working with LTSS waivers preferred

PHYSICAL REQUIREMENTS

  • Physicalhealth sufficient to meet the ergonomic standards and demands of the position.

PHYSICAL REQUIREMENTS

  • Physicalhealth 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!

Job ID 2018-5414

As an equal opportunity employer, Virginia Premier is committed to a diverse workforce. To ensure non-discrimination and affirmative action for individuals protected by Executive Order 11246, as amended, Section 503 of the Rehabilitation Act of 1973, as amended, the Vietnam Veterans’ Readjustment Act of 1974, as amended, and Title I of the Americans with Disabilities Act of 1990, as amended, Virginia Premier will consider applicants for employment without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. Applicants who require accommodation in the job application process may contact Recruitment at 804-819-5151 for assistance. It is the policy of Virginia Premier Health Plan, Inc., to comply with the requirements of the Drug-Free Workplace Act of 1988. It is a violation of our drug-free workplace policy to use, possess, sell, trade, and/or offer for sale alcohol, illegal drugs or intoxicants in our workplace. Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. Virginia Premier participates in E-verify.