Integrated Case Manager

Sentara Health•Norfolk, VA

4d•$89,544 - $136,469•Remote

About The Position

Sentara Health is hiring an Integrated Case Manager, RN. The position is remote but requires in-person, face-to-face assessments. The candidate must be able to travel to Roanoke and northern areas, with travel of up to 60–90 minutes to see members approximately 50–75% of the week. The Integrated Case Manager provides case management services within the scope of licensure and develops, monitors, evaluates, and revises member care plans to meet individual needs and optimize health care across the care continuum. The role performs telephonic clinical assessments to identify, evaluate, coordinate, and manage members’ physical and behavioral health, social service, and long-term service needs. The manager identifies members at risk of complications and coordinates care with members and the health care team. The role manages chronic illnesses, co-morbidities, and/or disabilities while supporting cost-effective and efficient use of health benefits, and conducts gap-in-care management for quality programs. The position supports care-plan implementation by facilitating authorizations and referrals within the benefits structure or through permissible extra-contractual arrangements. It interfaces with Medical Directors, Physician Advisors, and interdisciplinary teams regarding treatment plans and presents cases at multidisciplinary case conferences. The role also ensures compliance with regulatory, accrediting, and company policies and procedures and may help resolve provider, claims, or service issues. The position requires knowledge and abilities to address individualized physical, psychological, socio-cultural, spiritual, cognitive, and functional needs. Sentara offers a comprehensive benefits package. The organization describes its workplace as tobacco-free and identifies diversity, inclusion, and belonging as guiding principles.

Requirements

Registered Nurse certification/license required.
At least 3 years of nursing experience required.
Strong oral, written, and interpersonal communication skills.
Problem-solving, facilitation, and analytical skills.
Ability to address individualized physical, psychological, socio-cultural, spiritual, cognitive, and functional needs.
Must be able to travel to Roanoke and northern areas; travel may be up to 60–90 minutes and is required to see members approximately 50–75% of the week.

Nice To Haves

Bachelor’s degree preferred.
Managed care experience preferred.
Discharge planning experience preferred.

Responsibilities

Provide case management services within the scope of licensure.
Develop, monitor, evaluate, and revise member care plans to meet members’ needs and optimize care across the care continuum.
Perform telephonic clinical assessments to identify, evaluate, coordinate, and manage members’ physical and behavioral health, social service, and long-term service needs.
Identify members at risk of high-risk complications and coordinate care with members and the health care team.
Manage chronic illnesses, co-morbidities, and/or disabilities while supporting cost-effective and efficient utilization of health benefits.
Conduct gap-in-care management for quality programs.
Facilitate authorizations and referrals within the benefits structure or through permissible extra-contractual arrangements to support implementation of member care plans.
Interface with Medical Directors, Physician Advisors, and interdisciplinary teams regarding care management treatment plans.
Present cases at case conferences for multidisciplinary review.
Ensure compliance with regulatory, accrediting, and company policies and procedures.
May assist with resolving provider, claims, or service issues.
Travel to conduct in-person, face-to-face member assessments.

Benefits

Medical, dental, and vision plans.
Adoption, fertility, and surrogacy reimbursement up to $10,000.
Paid time off, sick leave, and holidays.
Paid parental and military leave; paid parental and family caregiver leave.
Emergency backup care.
Long-term and short-term disability and critical illness plans.
Life insurance.
401(k)/403(b) with employer match.
Educational assistance, tuition assistance up to $5,250 per year, and discounted educational opportunities through Guild Education.
Student loan repayment or student debt pay down up to $10,000.
Pet insurance.
Legal resources plan.
Opportunity to earn an annual discretionary bonus, subject to system and employee eligibility criteria.
Potential additional compensation, including shift differentials, on-call pay, shift premiums, extra-shift incentives, or bonus opportunities.