Nurse Case Manager-Northern Virginia/Winchester Region, VA(Arlington, Manassas, Woodbridge, Front Royal, Warrenton)
About The Position
Sentara Healthcare is hiring an Integrated Nurse Case Manager for the South West Virginia Region. This is a Full Time position with day shift hours. The role requires travel to conduct face-to-face home visits in members' homes or other locations within the specified region (Wise county, Lee county, Scott county, Dickenson county, Russel county, Washington county, Bristol). The primary goal is to optimize member health care across the care continuum by providing case management services within the scope of licensure. This includes developing, monitoring, evaluating, and revising care plans, performing clinical assessments (telephonic or face-to-face) for physical, behavioral health, social services, and long-term needs. The manager identifies high-risk members, coordinates care with the member and healthcare team, and manages chronic illnesses, co-morbidities, and disabilities to ensure cost-effective utilization of health benefits and conduct gap in care management for quality programs. The position also involves facilitating authorizations/referrals, interfacing with Medical Directors, Physician Advisors, and Inter-Disciplinary Teams, presenting cases at conferences, and ensuring compliance with policies and procedures.
Requirements
- Associates or Bachelors Degree in Nursing
- Registered Nurse License (RN) - Nursing License - Compact/Multi-State License required
- 3 years experience in Nursing
Nice To Haves
- Private duty nursing experience
- Knowledgeable with ventilators in a facility or home
- Discharge planning experience
- Managed Care experience
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
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.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
Number of Employees
5,001-10,000 employees
