About The Position
Sentara Health Plans is hiring an Integrated Nurse Case Manager/RN for Maternal Health/ Perinatal in Harrisonburg, Staunton, Lexington, Rockingham, Stuarts Draft, Luray, VA, and the surrounding areas! The position requires both in-person face-to-face assessments and remote telephonic assessments for the low and high risk pregnant population (Maternal Health / Perinatal / OB-GYN /Labor and Delivery / Mother-Baby / Postpartum) in Virginia Beach, Norfolk, Chesapeake, Suffolk and Portsmouth, VA and the surrounding areas. This is a Full-time, permanent position (40 hours) with standard working hours of 8am to 5pm EST, Monday through Friday. Applicants must reside in Harrisonburg, Staunton, Lexington, Rockingham, Stuarts Draft, Luray, VA, and the surrounding areas.
Requirements
- Registered Nurse (RN) License (Compact or Virginia) REQUIRED
- 3 years experience in Nursing REQUIRED
- 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.
Nice To Haves
- Bachelors Degree in Nursing preferred
- Case Management experience preferred
- Managed Care or Health Plan experience preferred
- Experience working with low and high risk pregnant population (Maternal Health / Perinatal / OB-GYN /Labor and Delivery / Mother-Baby / Postpartum) experience preferred
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.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
