Integrated Nurse Case Manger

City/State

Work Shift

Overview:

Sign-on bonus offer to qualified applicants!

This is a full-time, work-from-homeposition that requires travel to conduct face-to-face home visits in the member's home or other locations within the Central/Richmond, VA region.

Status: Full-time,permanent position (40 hours)

Standard working hours: 8am to 5pm EST, M-F

Location: Applicants must be reside in Central/Richmond, VA region!

Primary responsibilities include:

• Responsible for case management services within the scope of licensure; develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum

• Performs telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical and behavioral health, social services and long-term services

• Identifies members for high-risk complications and coordinates care in conjunction with the member and health care team

• Manages chronic illnesses, co-morbidities, and/or disabilities ensuring cost effective and efficient utilization of health benefits; conducts gap in care management for quality programs

• Assists with the implementation of member care plans by facilitating authorizations/referrals within benefits structure or extra-contractual arrangements, as permissible

• Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on care management treatment plans

• Presents cases at case conferences for multidisciplinary focus. Ensures compliance with regulatory, accrediting and company policies and procedures

• May assist in problem solving with provider, claims or service issues.

Education:

• Associate or Bachelors Degree in Nursing REQUIRED

Certification/Licensure:

• Registered Nurse (RN) License (Compact or Virginia) REQUIRED

Experience:

• 3 years experience in Nursing REQUIRED

• Case Management experience preferred

• Managed Care or Health Plan experience preferred

• Experience working with low and high risk pregnant population/Maternity/OB/L&D/Mother Baby/Postpartum experiencepreferred

• Strong knowledge of physical, psychological, socio-cultural, and cognitive patient needs.

• Excellent communication skills, both oral and written, as well as strong problem-solving and analytical

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.

Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.

We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services-all to help our members improve their health.

Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.

Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-76479

Talroo - Nursing

Care Coordination, Case Management, RN, Case Manager, Registered Nurse, BSN, ADN, Nursing, Richmond, Central, Managed Care, MCO, Health Plan, high-risk pregnant members, Maternity, OBGYN, Labor and Delivery

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission "to improve health every day," this is a tobacco-free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.