Case Manager Team Lead Job in Richmond 23220, Virginia US
Seeking Nurse Practitioner CNS or Certified RN case manager for enhanced care management program focusing on high risk Medicaid members utilizing telephonic and face to face nurse case manager visits integrated with a Multidisciplinary Team (MDT) and the members’ primary care physicians in an effort to enhance care quality and reduce medical utilization.
- Responsible for the comprehensive management of members with an Acute and CoMorbid illness.
- Responsible for the proactive management with the objective of improving quality outcomes and decreasing costs.
- Responsible for the early identification and assessment of members for admittance to a comprehensive case management program.
- Applies case management concepts principles and strategies in the development of an individualized care plan that addresses the member’s broad spectrum of needs.
- 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 including behavioral health providers health plan Medical Directors health services staff and the Multi-Disciplinary Team.
- Serves as the member's advocate to ensure they receive all necessary care allowed under their benefit plan. Develop knowledge of community resources and alternate funding arrangements available to the member when services are not available under their benefits program.
- Serves as a resource to other integrated complex case managers for clinical questions and coordination of care.
- Develops relationships with hospital social workers and community resources to assure appropriate management of catastrophic and chronically ill members.
Current Virginia NP or CNS license preferred; or
Certified Registered Nurse case manager wtih 3 or more years case management experience in a managed care setting
· Experience with using computer systems as part of the clinical activity and MS Office.
· Excellent assessment skills required.
· Ability to problem-solve and prioritize changing patient conditions.
· Strong interpersonal skills with the ability to build relationships with providers and members.
Excellent verbal written communication and listening skills
· Previous experience (usually 3+ year) in case management.
· Significant experience (usually 3+ years) clinical experience. Behavioral health experience is a plus.
Previous experience working with underserved populations and/or Medicaid.
VAPremier Health Plan Inc. an Equal Opportunity Employer offers generous benefits competitive salary and great work environment. Day hours and no weekends.