Integrated Case Manager - Registered Nurse in Norfolk, Virginia Beach, Chesapeake, Suffolk, VA

Sentara Health • Virginia Beach, VA

1d • Hybrid

About The Position

Sentara Health Plans is hiring an Integrated Case Manager - Registered Nurse in Norfolk, Virginia Beach, Chesapeake, Suffolk, VA! Status: Full-time, permanent position (40 hours) Standard working hours: 8 am to 5 pm EST, M-F The position requires both in-person/face-to-face assessments and remote telephonic assessments for the LTSS Waiver population in Norfolk, Virginia Beach, Chesapeake, Suffolk, VA! Primary responsibilities include: 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. 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!

Requirements

• Associate or Bachelors Degree in Nursing REQUIRED
• Registered Nurse (RN) License (Compact or Virginia) REQUIRED
• 3 years experience in Nursing REQUIRED

Nice To Haves

• Case Management experience preferred
• Health Plan, LTSS and Home Health experience preferred

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree