Integrated Case Manager

Sentara Hospitals•Harrisonburg, VA

23h•Hybrid

About The Position

Sentara Health in Harrisonburg VA is looking to hire an Integrated Case Manager, RN. This position will work with members under Sentara Health Plans who are both medically and behaviorally complex. This position requires both in-person/face-to-face assessments and remote telephonic assessments for members with Serious Mental Illnesses, Serious Emotional Disturbances (ages 2+) and Substance Abuse Disorders! Applicants must be in Harrisonburg, area VA. Travel may include up to 90 minutes one way. The Integrated Case Manager is 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. Ensure compliance with regulatory, accrediting and company policies and procedures. May assist in problem solving with provider, claims or service issues. Demonstrates the minimum knowledge, skills and abilities to care for the individualized needs of the patient to include physical, psychological, socio-cultural, spiritual and cognitive needs as well as functional abilities including the need for diversified use of such practices.

Requirements

Associates degree (required)
Registered Nurse (required)
3 years of nursing experience (required)
Strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills

Nice To Haves

Bachelors degree (preferred)
Managed care experience (preferred)
Discharge planning experience (preferred)

Responsibilities

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.
Ensure compliance with regulatory, accrediting and company policies and procedures.
May assist in problem solving with provider, claims or service issues.
Demonstrates the minimum knowledge, skills and abilities to care for the individualized needs of the patient to include physical, psychological, socio-cultural, spiritual and cognitive needs as well as functional abilities including the need for diversified use of such practices.

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
Pet Insurance
Legal Resources Plan
Annual discretionary bonus