Virginia Premier Health Plan Regional Transition Coordinator in Chesapeake, Virginia

Overview

Under the supervision of the Manager, the Regional Transition Coordinator is responsible for managing members who undergo transitions of the following:

  1. Hospitals (acute discharge) to:

  2. Nursing facility (skilled or custodial)

  3. Community with HCBS waiver

  4. Community without HCBS waiver

  5. Hospitals (psychiatric) discharge to:

  6. Nursing facility (skilled or custodial)

  7. Community with HCBS waiver

  8. Community without HCBS waiver

  9. Residential Treatment Facility

  10. HCBS waiver to:

  11. Hospital (acute or psychiatric)

  12. Nursing facility (skilled or custodial)

  13. Residential Treatment Facility

  14. Community without HCBS waiver to:

  15. Hospital (acute or psychiatric)

  16. Nursing facility (skilled or custodial)

  17. Community with HCBS waiver

  18. Residential Treatment Facility

  19. Long-term Institution transition to:

  20. Community with HCBS waiver

  21. Hospital and back to Nursing Facility

Unit Description

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

Participates in discharge planning for Members transitioning from acute institutional settings to lower levels of care, including Long Stay Hospitals, Nursing Facilities, and the community

  • Provides support to care coordinators to maintain Members in the community in lieu of transitioning to institutional settings, as needed.

  • Serves on the ICT for all members who are in transition

  • Facilitates communication and coordination between members of the health care team

  • 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

  • Strives to promote member self-advocacy and self-determination

  • Acts as an advocate for a member’s health care needs

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

Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • Bachelor degree in Health or Human Services OR;

  • Registered Nurse licensed to practice in the Commonwealth of Virginia (Bachelor preferred) OR;

  • Licensed Practical Nurse in the Commonwealth of Virginia

  • Certified Case Manager preferred

SPECIAL KNOWLEDGE AND OR SKILLS

  • Excellent oral and written communication skills

  • PC literate with working knowledge of Microsoft Office and various computer software programs

  • Working knowledge of community resource options, and experience in making appropriate referrals

  • Strong decision making skills and ability to handle multiple priorities

  • Knowledge of case management and transitions/discharge planning

  • Knowledge of home and community based service waivers needed

  • Some local travel may be necessary

ELIGIBILITY REQUIREMENTS

  • Must have valid Driver's license with positive points on DMV record.

  • Willing and able to conform to pre-employment background check

PHYSICAL REQUIREMENTS

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

A bout Us

Virginia Premier is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs. Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia.

We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.

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!

*CB

Job ID 2018-4769

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.