Overview
Integrated Nurse Case Manager responsible for case management services within the scope of licensure, developing, monitoring, evaluating, and revising member care plans to optimize healthcare across the continuum. Provides telephonic or face‑to‑face clinical assessments for physical, behavioral, social health, and long‑term services. Coordinates care for high‑risk complications, manages chronic illnesses, and facilitates authorizations/referrals. Interfaces with medical directors, physician advisors, interdisciplinary teams, and presents cases at multidisciplinary conferences.
Primary Responsibilities
Provide case management services within licensure scope, including care plan development and revision.
Perform telephonic or face‑to‑face assessments for member needs, including physical and behavioral health, social services, and long‑term care.
Identify members for high‑risk complications and coordinate care with the member and health care team.
Manage chronic illnesses, comorbidities, and disabilities ensuring cost‑effective utilization of health benefits and address gaps in care.
Assist with implementation of member care plans by facilitating authorizations/referrals within benefit structures.
Interface with Medical Directors, Physician Advisors, and interdisciplinary teams for treatment plan management.
Present cases at case conferences for multidisciplinary focus, ensuring compliance with regulatory, accrediting and company policies.
Assist in problem‑solving with provider, claims or service issues.
Education
Associate or Bachelor’s Degree in Nursing (required).
Certification / Licensure
Registered Nurse (RN) license (Compact or Virginia) required.
Experience
Minimum 3 years of nursing experience (required).
Case management experience preferred.
Managed care or health plan experience preferred.
Experience with low and high‑risk maternity/pregnancy populations (preferred).
Strong knowledge of physical, psychological, socio‑cultural, and cognitive patient needs.
Excellent oral and written communication skills, strong problem‑solving and analytical abilities.
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 and short‑term disability, and critical illness plans
Life insurance
401(k)/403(b) with employer match
Tuition assistance – $5,250 per year and discounted educational opportunities
Student debt paydown – $10,000
Reimbursement for certifications and CEUs
Pet insuranceLegal resources plan
Opportunities to earn discretionary bonus per eligibility criteria.
EEO Statement
Sentara Health is an equal opportunity employer and prides itself on diversity and inclusiveness of its workforce. For positions that are available as remote work, Sentara Health employs associates in 51 states.
Contact
To apply, go to www.sentaracareers.com and use keyword JR‑89064.