Nurse Case Manager

Sentara Hospitals • Virginia Beach, VA

6d • Hybrid

About The Position

Sentara Health Plans is currently hiring an Integrated Nurse Case Manager in the Hampton and Newport News area of Virginia Status: Full Time (40 hrs/wk) Shift: Day (8am-5pm) Position is remote but does require in person face-to-face assessments multiple times throughout the week. Candidates must be able to travel frequently throughout the week to complete in person assessments. Location of assessments include : Peninsula including Hampton, Newport News, Poquoson, Smithfield, Isle of White, Ivor, Gloucester/surrounding area, with potential to travel to the Southside

Requirements

• Associates or Bachelors Degree in Nursing (Required)
• Virginia or Compact RN License (Required)
• 3 years experience in Nursing (Required)
• Experience in Private Duty Nursing or NICU or Experience working with Ventilators (Required)

Nice To Haves

• Private duty nursing experience and knowledgeable with ventilators in a facility or home
• Discharge planning experience (Preferred)
• Managed Care 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees