Virginia Premier Health Plan Supervisor, Care Coordination in Alexandria, 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

This position is responsible for supervising MLTSS care coordination staff, providing daily oversight of all care coordination activities performed by staff, and supporting leadership in MLTSS program enhancements.

Responsibilities

  • Supervises day-to-day model of care (MOC) activities performed by staff for the MLTSS program including assessments, individualized care plans, interdisciplinary care team meetings, transitions, and care coordination.

  • Maintains appropriate staffing levels and assignments to ensure excellent customer service and meet regulatory timeframes.

  • Works with care coordination staff to provide guidance and/or intervention in problematic/unusual cases

  • Assists with onboarding new staff and ongoing mentoring/coaching of care coordinator staff

  • Serves in an advisory capacity for problem solving, reviewing reports being sent to internal and external customers, reviewing problematic cases, and monitor medical management activities in collaboration with the manager

  • Maintains resources, keeping information up-to-date

  • Supports Manager in ongoing quality improvement initiatives by assisting with various quality review tasks such as collecting and analyzing data as outlined in the program

  • Participates in assigned VPHP meetings to educate providers and/or members (which may occur outside of normal business hours)

  • Provides Manager with documentation on individual team members’ performance on a regular basis

  • Performs annual/interim appraisals of care coordinator staff as assigned

  • Collaborates with the Manager and Human Resources team develop, implement, and monitor corrective action plans for staff as appropriate

  • Assists in the ongoing development of programs and care coordination projects to enhance/expand the department

  • Maintains confidentiality of patient information, and VPHP proprietary operational information

  • Maintains current knowledge of VPHP policies and procedures

  • Participates in continuing education activities as appropriate

  • Participate in quality audits; ensuring staff is meeting quality and productivity metrics

Qualifications

EDUCATION/CERTIFICATION REQUIREMENTS:

  • Registered Nurse licensed to practice nursing in Virginia; or

  • Licensed Clinical Social Worker; or

  • Licensed Mental Health Professional

  • Certified Case Manager (CCM) is a plus

  • Minimum of 1 year supervisory experience

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Strong oral and written communication skills

  • Knowledge of community resources and vendor options and experience in making appropriate referrals

  • Possess knowledge of Medicare and Medicaid programs

  • Ability to communicate effectively with individuals who have complex medical and/or behavioral health needs

  • Proficiency in Microsoft Office applications (Excel, PP, Word)

WORK BACKGROUND/EXPERIENCE

  • Minimum of 1 year working experience in a long term care, home health, public health, behavioral health, or Medicaid managed care setting

  • Experience working with low-income, disadvantaged, disabled, elderly, and vulnerable populations

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 2018-4892

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.