Integrated Nurse Case Manager/Registered Nurse (RN)
Sentara Health is hiring an Integrated Nurse Case Manager / Registered Nurse (RN) in Fredericksburg, VA and surrounding areas. This is a full‑time, permanent position (40 hours per week) with standard working hours 8 am to 5 pm EST Monday through Friday.
Overview
The Integrated Nurse Case Manager/Registered Nurse (RN) is responsible for case management services within the scope of RN licensure. Duties include developing, monitoring, evaluating, and revising members' care plans; performing telephonic or face‑to‑face clinical assessments; identifying high‑risk members; managing chronic illnesses and co‑morbidities; coordinating authorizations and referrals; and presenting cases at multidisciplinary conferences. Both in‑person and remote telephonic assessments are required for the LTSS waiver population.
Responsibilities
Provide case management services within the scope of RN licensure, developing and revising member care plans.
Perform telephonic or face‑to‑face clinical assessments to identify, evaluate, and coordinate member needs, including physical, behavioral, and social services.
Identify members at risk for high‑complication outcomes and coordinate care with the member and health‑care team.
Manage chronic illnesses, co‑morbidities, and/or disabilities to ensure cost‑effective and efficient utilization of health benefits.
Assist with implementation of member care plans by facilitating authorizations and referrals within the benefit structure or extra‑contractual arrangements as permissible.
Interface with Medical Directors, Physician Advisors, and Inter‑Disciplinary Teams on treatment plans.
Present cases at case conferences, ensuring compliance with regulatory, accrediting, and company policies and procedures.
Assist in problem‑solving with providers, claims, or service issues.
Qualifications
Registered Nurse (RN) license (Compact or Virginia) – required.
Associate or Bachelor’s degree in Nursing – required.
Three (3) years of nursing experience – required.
Preferred Qualifications
Case management experience – preferred.
Discharge planning experience – preferred.
Managed care or health‑plan experience – preferred.
Location
Applicants must reside in Fredericksburg, VA or surrounding areas such as Locust Grove, VA.
Work Shift
First (Days).
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 free access to CEUs and professional development.
Pet Insurance.
Legal Resources Plan.
Opportunities to earn an annual discretionary bonus based on established criteria.
Equal Opportunity Employment
Sentara Health is an equal‑opportunity employer and prides itself on diversity and inclusion. This is a tobacco‑free environment.