Nurse Case Manager

City/State

Work Shift

Overview:

Sentara Health Plans is currently hiring an Integrated Nurse Case Manager in Tidewater Virginia

Status: Full Time (40 hrs/wk)

Shift: Day (8am-5pm)

Location: Remote* in Tidewater VA (Requires Travel)

*Position is remote but does require in person face-to-face assessments multiple times throughout the week. Candidates must be able to travel frequently throughout the week to complete in person assessments.

Location of assessments include : Peninsula including Hampton Newport News Poquoson Smithfield Isle of White Ivor Gloucester/surrounding area with potential to travel to the Southside

Primary responsibilities include:

• Responsible for case management services within the scope of licensure; develops monitors evaluates and revises the members care plan to meet the members 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 members 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

Preferred: Private duty nursing experience and knowledgeable with ventilators in a facility or home

Education

• Associates or Bachelors Degree in Nursing (Required)

Certification/Licensure

• Virginia or Compact RN License (Required)

Experience

• 3 years experience in Nursing (Required)

• Experience in Private Duty Nursing or NICU or Experience working with Ventilators (Required)

• Discharge planning experience (Preferred)

• Managed Care experience (Preferred)

Keywords: Care Coordination Case Management Human Services Community Health Health Education RN Case Manager Registered Nurse BSN ADN Private Duty Ventilator LinkedIn Talroo-Nursing

Benefits: Caring For Your Family and Your Career

Medical Dental Vision plans

Adoption Fertility and Surrogacy Reimbursement up to $10000

Paid Time Off and Sick Leave

Paid Parental & Family Caregiver Leave

Emergency Backup Care

Long-Term Short-Term Disability and Critical Illness plans

Life Insurance

401k/403B with Employer Match

Tuition Assistance $5250/year and discounted educational opportunities through Guild Education

Student Debt Pay Down $10000

Reimbursement for certifications and free access to complete CEUs and professional development

Pet Insurance
Legal Resources Plan
Colleagues have the opportunity to earn an annual discretionary bonus ifestablished system and employee eligibility criteria is met.

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30000-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.

Required Experience:

Manager