Virginia Premier Health Plan LTSS Care Specialist/ Coordinator in Danville, Virginia
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!
Long Term Services and Support Care Specialists/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 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.
POSITION DUTIES AND 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.
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.
Empowers the member to problem solve by exploring options of care, when available, and alternative plans, when necessary, to achieve desired outcomes
Acts as an advocate for a member’s health care needs
MINIMUM EDUCATION REQUIREMENTS
Bachelors of Science in a Health Services field required OR
Registered Nurse licensed to practice in the Commonwealth of Virginia OR
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
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
Must have valid Driver's license with positive points on DMV record.
Willing and able to conform to pre-employment background check
- 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!
Job ID 2018-5384
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.