About The Position
Sentara Health Plans is hiring an Integrated Care Manager/ Registered Nurse (RN) for Long-Term Services and Supports (LTSS) Waiver Members/Medicaid. This is a full-time, permanent position requiring 40 hours per week with standard working hours from 8 am to 5 pm EST, Monday through Friday. The role involves in-person/face-to-face assessments and remote work from a home office, serving LTSS Waiver Members/Medicaid in Northern Virginia (Fairfax, Springfield, and Alexandria, VA) and surrounding areas, with travel up to a maximum of 1 hour. The candidate must reside in Northern Virginia.
Requirements
- Registered Nurse (RN) License (Compact or Virginia) REQUIRED
- 3 years experience in Nursing REQUIRED
Nice To Haves
- Bachelor's Level Degree in Nursing preferred
- Managed Care/ Health Plan/ Health Insurance experience highly preferred
- Case Management experience preferred
- Long-Term Services and Supports (LTSS) waiver and Home Health experience preferred
- Behavioral Health experience is secondary
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.
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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
