Integrated Case Manager- RN

Sentara Hospitals•Richmond, VA

3d•$89,544 - $136,469•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 address individual needs and optimize health care across the care continuum. It performs telephonic clinical assessments to identify, evaluate, coordinate, and manage members’ physical and behavioral health, social service, and long-term service needs. The position is remote but requires in-person face-to-face assessments and travel to the Bowling Green, Tappahannock, and Henrico areas of Virginia. The case manager identifies members at risk for complications and coordinates care with members and their health care teams. The role supports management of chronic illnesses, comorbidities, and disabilities; promotes efficient and cost-effective use of health benefits; and conducts gap-in-care management for quality programs. It also facilitates authorizations and referrals within the benefits structure or through permissible extra-contractual arrangements, works with Medical Directors, Physician Advisors, and Inter-Disciplinary Teams on treatment plans, and presents cases at multidisciplinary conferences. The role ensures compliance with regulatory, accrediting, and company requirements and may help resolve provider, claims, or service issues. This is a full-time, 40-hour-per-week position on a day shift, 8 a.m.–5 p.m. The posted annual base-pay range is $89,544.00–$136,468.80. Additional compensation may be available, and compensation within the range may depend on qualifications, experience, location, market conditions, and business needs.

Requirements

Registered Nurse licensure is required.
At least 3 years of nursing experience is required.
Strong oral, written, and interpersonal communication skills.
Problem-solving, facilitation, and analytical skills.
Ability to address individualized patient needs, including physical, psychological, sociocultural, spiritual, cognitive, and functional needs.

Nice To Haves

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

Responsibilities

Develop, monitor, evaluate, and revise member care plans to meet member needs and optimize care across the care continuum.
Perform telephonic clinical assessments to identify, evaluate, coordinate, and manage physical and behavioral health, social service, and long-term service needs.
Identify members at risk for high-risk complications and coordinate care with members and their health care teams.
Manage chronic illnesses, comorbidities, and disabilities while supporting cost-effective, 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.
Coordinate 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 related to provider, claims, or service issues as needed.
Provide care that considers individualized physical, psychological, sociocultural, spiritual, cognitive, and functional needs.
Travel to provide in-person face-to-face assessments in the Bowling Green, Tappahannock, and Henrico areas.

Benefits

Medical, dental, and vision plans and insurance.
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, family caregiver, and military leave.
Adoption, fertility, and surrogacy reimbursement up to $10,000.
Emergency backup care.
Educational assistance and tuition assistance of up to $5,250 per year, with discounted educational opportunities through Guild Education.
Student loan repayment or student debt pay down of up to $10,000.
Pet insurance.
Legal resources plan.
Opportunity to earn an annual discretionary bonus, subject to established system and employee eligibility criteria.
Additional compensation may include shift differentials, on-call pay, shift premiums, extra-shift incentives, or bonus opportunities.