Overview Sentara Health Plans is hiring an Integrated Nurse Case Manager/RN in Chesapeake, VA and surrounding areas!
Position requires both in-person face-to-face assessments and remote telephonic assessments for the waiver population in Chesapeake, VA and surrounding areas.
Status Full-time, permanent (40 hours)
Standard Working Hours 8am to 5pm EST, M-F
Location Applicants must reside in 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.
Required Qualifications Registered Nurse (RN) License (Compact or Virginia) REQUIRED
Associate or Bachelors Degree in Nursing REQUIRED
3 years experience in Nursing REQUIRED
Preferred Qualifications Case Management experience preferred
Discharge planning experience preferred
Managed Care or Health Plan experience preferred
Education Bachelors 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
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
Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer 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.
Remote Work Locations 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.