Integrated Nurse Case Manager/Registered Nurse/RN for Chronic/Complex Condition in Hampton, Newport News, Yorktown, Williamsburg, VA
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! Status: Full-time, permanent position (40 hours) Standard working hours: 8am to 5pm EST, M-F Location: 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
- Annual discretionary bonus if established system and employee eligibility criteria is met.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
