Welcome to Piedmont Community Health Plan's jobs page. As Central Virginia's very own managed healthcare organization, we're dedicated to providing our members with access to medical care that represents the highest standards for quality and efficiency.
To view and or apply for any of the following positions, click CENTRA HEALTH CAREERS and follow the prompts:
- Scroll to the bottom and select "Piedmont Community Health Plan" from the "Select a Facility" box.
- You may further your search by selecting a job category or job status.
- Click on "Search."
Current Job Openings
The responsible for maintaining and reconciling specific accounts of the health plan.
Responsible for the day to day implementation of the case management programs. Assure effective interface and cooperation with other departments in order to implement effective patient care and achieve medical management goals.
ESSENTIAL FUNCTIONS/TYPICAL TASKS:
These are intended only as illustrations of the various types of work performed. The omission of specific duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.
- Implements departmental policy and procedures to assure effective case management program under the direction of the Piedmont Chief Medical Officer and Medical Directors
- Performs utilization review duties as assigned
- Identifies members who qualify for case management
- Assists with discharge planning for members changing levels of care
- Institutes a care management plan
- Completes comprehensive assessments for members enrolled in case management in order to institute a care management plan
- Interacts with network physicians and facilities to assist with care coordination
- Other duties as assigned
Customer Service Representative
- Provide information to members, providers and clients in response to inquiries about the health plan.
- Professionally handle incoming calls from members, providers or clients and ensure that issues are resolved both promptly and thoroughly.
- Thoroughly and efficiently gather all pertinent information (HIPPA) before providing any information out to the caller.
- Maintain a balance between company policy and member benefit in decision making. Handles issues in the best interest of both member and company. Utilize all tools provided to assist the caller and resolution during initial call.
- Completes thorough documentation in the system regarding call.
This individual assists the Product Manager of Government Programs – Exchange/Affordable Care Act(ACA) with government healthcare plan daily operation functions. These duties include, but are not limited to: investigating and resolving Health Insurance Casework System(HICS) cases, supporting enrollment discrepancy resolutions, track and chart product metrics, assisting the claims/enrollment Third-Party Administrator (TPA) with reconciliation of Centers for Medicare & Medicaid Services (CMS)/Piedmont records, addressing complex inquiries/issues internally and externally, performing member outreach, process returned mail, and support process improvement initiatives.
Responsible for the calculation of premium rates, analyzes factors that affect revenue and develops revenue projections.
Utilization Review Clerk
The Utilization Review Clerk II provides support services for office processes including utilization review for the Medical Management department. They will assist with initial processing of incoming authorization requests, facilitating interdepartmental communication and data entry and basic systems administration for Medical Management systems. This position also provides primary and initial phone customer service to both members and providers. The Utilization Review Clerk is also delegated the responsibility of approving specific benefit authorizations and works under the supervision of an appropriately licensed health professional.
Utilization Review Nurse
Piedmont Community Health Plan's medical management department is searching for a full time Registered Nurse to join our team.
This role performs utilization review services for a variety of services, including both inpatient and outpatient services, within the established criteria and regulatory timeframes. The nurse will promote effective utilization and monitoring of health services. The nurse will communication and collaborate with providers and members to manage coverage of services. The nurse will refer members to case management as appropriate.
As a local employer of choice, Piedmont is committed to diversity. As such, we are an Equal Employment Opportunity and Affirmative Action Employer. Please see below for current job openings. Thank you for your interest in Piedmont Community Health Plan.