Integrated Case Manager- RN (Northern Virginia)

Sentara Hospitals•Fairfax, VA

3d•Remote

About The Position

Sentara Health is hiring an Integrated Case Manager, RN, to provide case management services within the scope of licensure. The role develops, monitors, evaluates, and revises member care plans to meet individual needs and optimize health care across the care continuum. It performs telephonic clinical assessments to identify, evaluate, coordinate, and manage physical and behavioral health, social service, and long-term service needs. The position identifies members at risk for complications and coordinates care with members and their health care teams, while managing chronic illnesses, comorbidities, and disabilities and supporting efficient, cost-effective use of health benefits. The role also conducts gap-in-care management for quality programs and facilitates authorizations and referrals within benefit structures or permissible extra-contractual arrangements. The Integrated Case Manager collaborates with Medical Directors, Physician Advisors, and Inter-Disciplinary Teams on treatment plans and presents cases at multidisciplinary case conferences. The position ensures compliance with regulatory, accrediting, and company policies and procedures and may help resolve provider, claims, or service issues. It requires knowledge and skills to address patients’ physical, psychological, sociocultural, spiritual, cognitive, and functional needs. This is a full-time, remote position with required in-person, face-to-face assessments. The employee must be able to travel to the Arlington, Alexandria, Fairfax, and Leesburg areas. The stated schedule is day shift, 8 a.m.–5 p.m., 40 hours per week.

Requirements

Registered Nurse (RN) required.
At least 3 years of nursing experience required.
Strong oral, written, and interpersonal communication skills.
Problem-solving, facilitation, and analytical skills.
Ability to travel to Arlington, Alexandria, Fairfax, and Leesburg for in-person assessments.

Nice To Haves

Bachelor’s degree preferred; an associate degree is listed as education.
Managed care experience preferred.
Discharge planning experience preferred.

Responsibilities

Develop, monitor, evaluate, and revise member care plans to meet needs and optimize health 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 for complications and coordinate care with members and their health care teams.
Manage chronic illnesses, comorbidities, and 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 permissible extra-contractual arrangements to implement member care plans.
Interface with Medical Directors, Physician Advisors, and Inter-Disciplinary Teams on care management treatment plans.
Present cases at case conferences for multidisciplinary review.
Ensure compliance with regulatory, accrediting, and company policies and procedures.
Assist with problem-solving provider, claims, or service issues as needed.
Address patients’ individualized physical, psychological, sociocultural, spiritual, cognitive, and functional needs.
Conduct required in-person, face-to-face assessments and travel to the Arlington, Alexandria, Fairfax, and Leesburg areas.

Benefits

Medical, dental, and vision plans.
Life and disability insurance, including long-term and short-term disability and critical illness plans.
401(k)/403(b) with employer match.
Paid time off, sick leave, and holidays.
Paid parental and military leave; paid parental and family caregiver leave.
Adoption, fertility, and surrogacy reimbursement up to $10,000.
Emergency backup care.
Educational assistance and tuition assistance of $5,250 per year, with discounted educational opportunities through Guild Education.
Student loan repayment or student debt pay down up to $10,000.
Voluntary benefits, including pet insurance and a legal resources plan.
Opportunity to earn an annual discretionary bonus if system and employee eligibility criteria are met.