Overview
Sentara Health Plans is hiring an Integrated Nurse Case Manager/RN to provide case management services for the Long‑Term Services and Support (LTSS) waiver population in Williamsburg, Yorktown, Newport News, Hampton, VA, and surrounding areas. The role includes both in‑person face‑to‑face assessments and remote telephonic assessments.
Status: Full‑time, permanent (40 hours). Standard working hours: 8 am to 5 pm EST, Monday‑Friday. Applicants must reside in the listed Virginia locations.
Primary responsibilities include:
Provide case management services within the scope of licensure; develop, monitor, evaluate, and revise member care plans to optimize health across the care continuum.
Perform telephonic or face‑to‑face clinical assessments for identification, evaluation, coordination, and management of member needs, including physical, behavioral health, social services, and long‑term services.
Identify members for high‑risk complications and coordinate care with members and the health care team.
Manage chronic illnesses, comorbidities, and/or disabilities, ensuring cost‑effective and efficient utilization of health benefits; conduct gaps in care management for quality programs.
Assist with the implementation of member care plans by facilitating authorizations/referrals within the benefits structure or extra‑contractual arrangements, as permissible.
Interface with Medical Directors, Physician Advisors, and interdisciplinary teams on care management treatment plans.
Present cases at case conferences for multidisciplinary focus and ensure compliance with regulatory, accrediting, and company policies and procedures.
Assist in problem‑solving with providers, claims, or service issues as needed.
Required Qualifications
Registered Nurse (RN) License (Compact or Virginia) – REQUIRED
Associate or Bachelor’s Degree in Nursing – REQUIRED
Three (3) years’ experience in nursing – REQUIRED
Preferred Qualifications
Case Management experience – preferred
Discharge planning experience – preferred
Managed Care or Health Plan experience – preferred
Education
Bachelor’s Degree in Nursing – preferred
Certification/Licensure
Registered Nurse (RN) License (Compact or Virginia) – REQUIRED
Benefits
Medical, Dental, Vision plans
Adoption, Fertility and Surrogacy Reimbursement up to $10,000
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
401(k)/403(b) with Employer Match
Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
Student Debt Pay Down – $10,000
Reimbursement for certifications and access to CEUs and professional development
Pet Insurance
Legal Resources Plan
Opportunity to earn an annual discretionary bonus subject to system and employee eligibility criteria.
Equal Opportunity Employer Statement
Sentara Health is an equal opportunity employer and prizes diversity, inclusion, and belonging within its near 30,000‑member workforce. All positions ensure compliance with the U.S. Equal Employment Opportunity Commission (EEOC) and other applicable laws. This is a tobacco‑free environment.
To apply, please visit www.sentaracareers.com and use the keyword “JR‑88757”.