Integrated Case Manager

Sentara Hospitals • Roanoke, VA

3d • Remote

About The Position

Sentara Health is hiring an Integrated Case Manager, RN. The position is remote but includes in-person face-to-face assessments. Candidates 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 members’ needs and optimize their health care across the care continuum. The role performs telephonic clinical assessments to identify, evaluate, coordinate, and manage member needs, including physical and behavioral health, social services, and long-term services. It identifies members at risk of complications and coordinates care with members and their health care teams.

The role also manages chronic illnesses, comorbidities, and disabilities to support cost-effective and efficient use of health benefits, and conducts gap-in-care management for quality programs. It facilitates authorizations and referrals within the benefits structure or through permissible extra-contractual arrangements; interfaces with Medical Directors, Physician Advisors, and interdisciplinary teams on care management 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. The employee must provide care that addresses individualized physical, psychological, sociocultural, spiritual, cognitive, and functional needs.

Requirements

• Registered Nurse licensure is required.
• At least 3 years of nursing experience.
• Strong oral, written, and interpersonal communication skills.
• Problem-solving, facilitation, and analytical skills.
• Ability to travel to Roanoke and northern areas, including travel of up to 60–90 minutes to see members approximately 50–75% of the week.

Nice To Haves

• Bachelor’s degree preferred; an associate degree is listed as the education level.
• 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 member 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 of high-risk 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 through permissible extra-contractual arrangements.
• 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.
• Assist with problem-solving provider, claims, or service issues as needed.
• Address individualized physical, psychological, sociocultural, spiritual, cognitive, and functional needs in care.
• Conduct in-person face-to-face member assessments and travel to Roanoke and northern 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 up to $5,250 per year
• Student loan repayment or student debt pay down up to $10,000
• Discounted educational opportunities through Guild Education
• Pet insurance
• Legal resources plan
• Opportunity to earn an annual discretionary bonus, subject to system and employee eligibility criteria

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree