Complex Condition in Fredericksburg, Spotsylvania, VA

Sentara Health•Fredericksburg, VA

1d•$89,544 - $136,469•Remote

About The Position

Sentara Health Plans is hiring a full-time, permanent Integrated Nurse Case Manager/RN to provide case management services to members with chronic or complex conditions in Fredericksburg, Spotsylvania, Virginia, and surrounding areas. This is a work-from-home position requiring travel for face-to-face home visits approximately two to three times per week. Applicants must reside in the specified service area. Standard hours are 8 a.m. to 5 p.m. Eastern Time, Monday through Friday, for 40 hours per week. The role provides case management within the scope of nursing licensure, with the goal of optimizing member health across the care continuum. The nurse assesses and coordinates members’ physical and behavioral health, social service, and long-term service needs. Target populations include high emergency-room utilizers, members recently discharged from a hospital, and members with conditions such as asthma, diabetes, heart failure, cancer, heart disease, or COPD. Sentara Health Plans provides coverage to nearly one million members in Virginia through commercial, individual and family, employee assistance, Medicare, and Medicaid plans. The organization offers a provider network and programs supporting members with chronic illnesses, wellness, and integrated clinical and behavioral health services. Sentara describes its culture as family-friendly, community-oriented, and supportive of development and growth.

Requirements

Associate or bachelor's degree in Nursing.
Registered Nurse (RN) license in Virginia or a compact-state license.
At least 3 years of nursing experience.
Strong knowledge of physical, psychological, sociocultural, and cognitive patient needs.
Excellent oral and written communication skills.
Strong problem-solving and analytical skills.
Must reside in Fredericksburg, Spotsylvania, Virginia, or the surrounding areas.

Nice To Haves

Case management experience.
Managed care or health plan experience.
Experience working with members with chronic or complex conditions such as asthma, diabetes, heart failure, cancer, heart disease, or COPD.
Experience in home health, inpatient case management, hospice, transition of care, or discharge planning.

Responsibilities

Develop, monitor, evaluate, and revise member care plans to meet members’ needs and optimize health care across the care continuum.
Conduct telephonic or face-to-face 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 complications and coordinate care with the member and health care team.
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 to help implement member care plans.
Interface with Medical Directors, Physician Advisors, and/or interdisciplinary teams regarding care management treatment plans.
Present cases at case conferences to support a multidisciplinary focus.
Ensure compliance with regulatory, accrediting, and company policies and procedures.
May help resolve provider, claims, or service issues.
Travel to conduct face-to-face home visits, approximately two to three times per week.

Benefits

Medical, dental, and vision plans.
Adoption, fertility, and surrogacy reimbursement up to $10,000.
Paid time off and sick leave.
Paid parental and family caregiver leave.
Emergency backup care.
Long-term and short-term disability and critical illness plans.
Life insurance.
401(k)/403(b) with employer match.
Tuition assistance of $5,250 per year and discounted educational opportunities through Guild Education.
Student debt pay down up to $10,000.
Pet insurance.
Legal resources plan.
Opportunity to earn an annual discretionary bonus, subject to system and employee eligibility criteria.
Market-competitive compensation, incentives, and benefits; additional compensation may include shift differentials, on-call pay, shift premiums, extra-shift incentives, or bonus opportunities.