Integrated Case Manager - RN/Registered Nurse- LTSS Waiver/Home Health in Culpeper, Fauquier, Madison, Orange, Rappahannock, VA

Sentara Hospitals • Virginia Beach, VA

6d • Hybrid

About The Position

Sentara Health Plans is hiring an Integrated Case Manager - Registered Nurse (RN) for LTSS/ Home Health in Culpeper, Warrenton, Fauquier, Catlett, Madison, Orange, Brightwood, Bealeton, Washington, Rappahannock County, Gordonsville, VA! This is a full-time, permanent position (40 hours) with standard working hours of 8am to 5pm EST, Monday through Friday. The position requires both in-person/face-to-face assessments and remote/home office work for the LTSS Waiver population in the specified Virginia counties. The candidate must reside in one of these counties: Culpeper, Warrenton, Fauquier, Catlett, Madison, Orange, Brightwood, Bealeton, Washington, Rappahannock County, Gordonsville, VA.

Requirements

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

Nice To Haves

• 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
• Bachelor's Level Degree 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