Complex Condition in Hampton, Newport News, Yorktown, Williamsburg, VA

Sentara Health•Hampton, VA

9d•Hybrid

About The Position

Sentara Health Plans is hiring an Integrated Nurse Case Manager/Registered Nurse/RN for Chronic/Complex Condition in Hampton, Newport News, Yorktown, Williamsburg, VA, and the surrounding areas. This is a full-time, work-from-home position that requires travel to conduct face-to-face home visits (target of at least 12 monthly) for chronic/complex condition members (asthma, diabetes, heart failure, cancer, heart disease, COPD) in Hampton, Newport News, Yorktown, Williamsburg, VA, and the surrounding areas. The position is a full-time, permanent role with standard working hours of 8 am to 5 pm EST, Monday through Friday. Applicants must reside in Hampton, Newport News, Yorktown, Williamsburg, VA, and the surrounding areas.

Requirements

Associate or Bachelors Degree in Nursing REQUIRED
Registered Nurse (RN) License (Compact or Virginia) REQUIRED
3 years experience in Nursing REQUIRED

Nice To Haves

Case Management experience highly preferred
Managed Care or Health Plan experience preferred
Experience working with chronic/complex condition members (Asthma, diabetes, heart failure, cancer, heart disease, COPD) preferred
Experience in home health experience, inpatient case management, hospice, transition of care, and discharge planning preferred
Strong knowledge of physical, psychological, socio-cultural, and cognitive patient needs.
Excellent communication skills, both oral and written, as well as strong problem-solving and analytical skills.

Responsibilities

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. Ensures compliance with regulatory, accrediting and company policies and procedures.
May assist in problem solving with provider, claims or service issues.

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
Reimbursement for certifications and free access to complete CEUs and professional development
Pet Insurance
Legal Resources Plan
Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.