Overview City/State: Lexington, VA
Work Shift: First (Days)
Overview: Sentara Health Plans is hiring an Integrated Nurse Case Manager/RN/Maternity/OBGYN for Lexington, Buena Vista, Millboro, Goshen, Warm Springs, McDowell and surrounding areas!
This is a full-time, work-from-home position that requires travel to conduct face-to-face home visits for low and high risk pregnant population/members' homes or other locations in Lexington, Buena Vista, Millboro, Goshen, Warm Springs, McDowell and surrounding areas.
Status: Full-time, permanent position (40 hours)
Standard working hours: 8am to 5pm EST, M-F
Location: Applicants must reside in Lexington, Buena Vista, Millboro, Goshen, Warm Springs, McDowell and surrounding areas
Primary responsibilities 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 experience preferred
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-89064
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Talroo - Nursing
Care Coordination, Case Management, RN, Case Manager, Registered Nurse, BSN, ADN, Nursing, Managed Care, MCO, Health Plan, high-risk pregnant members, Maternity, OBGYN, Labor and Delivery, Mother and Baby, Postpartum, L&D, Lexington, Buena Vista, Millboro, Goshen, Warm Springs, McDowell
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
401k/403B 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 free access to complete CEUs and professional development
Pet Insurance, Legal Resources Plan
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 remote positions, 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.