Certification Required or Eligible
RN Required or Eligible
5 years of experience required
Job Summary: Works under the supervision of the PACE Quality Director. Responsible for designing, implementing, directing, & evaluating PACE-wide Care Management program, to include policy & operational development. Functions include: medical necessity reviews, care planning, clinical documentation, & management of claims appeals, with a focus on ensuring consistently applied utilization processes are in place for hospitals & skilled nursing facilities. Responsible for staying up to date with any regulatory changes regarding PACE & impacting care management. Develops & revises policies & procedures, monitors performance, & coaches staff. Participation in process improvement; survey preparedness; & collaboration within PACE community, Riverside Health System, & outside entities as necessary. Functions as part of the PACE leadership team to establish strategic plans & objectives (i.e. clinical outcomes, service level targets, financial targets, & development & implementation of new programs).
Education: Requires Bachelors Degree in Nursing; Advanced degree strongly preferred.
Certification & Licensures Minimum Requirements: Current unrestricted Virginia RN license required. Certification as a case manager (CCM) required. Valid drivers license and acceptable driving record required upon hire and to be maintained during employment.
Experience Requirements: 5 years of progressive management experience. Prior PACE experience preferred. Previous Care Management experience required. Must provide proof of minimum one (1) year experience working with the frail and/or elderly population in any capacity.
Hours: primarily day shift Monday thru Friday. May require routine travel to PACE locations in Newport News, Richmond, and Charlottesville, Virginia.