Integrated Nurse Case Manager

City/State

Richmond, VA

Work Shift

First (Days)

Overview:

Sentara Health Plans is hiring a Nurse Case Manager for the Health Care Services Department.  

This is a remote position however traveling to Nursing Facilities and Members Home is required in the TW area VA Beach/Norfolk or Richmond and its surroundings in Virginia.

Key Responsibilities:

• Develop and implement individualized care plans for members to address their physical, behavioral, social, and long-term care needs.
• Perform face-to-face clinical assessments to identify, evaluate, and manage members’ needs.
• Coordinate care for high-risk members, including those with chronic conditions, co-morbidities, or disabilities.
• Manage care to ensure cost-effective and efficient utilization of health benefits, including conducting gap-in-care management for quality programs.
• Facilitate authorizations, referrals, and care plan implementation within benefits and coverage structures.
• Work closely with Medical Directors, Physician Advisors, and Interdisciplinary Teams to present and discuss case management treatment plans.
• Ensure compliance with regulatory, accrediting, and company policies and procedures.
• Assist with problem-solving related to provider, claims, or service issues as needed.

Education:

• Associate or bachelor’s degree in nursing

Certification:

• RN License (Virginia/Compact)

Experience:

• Nursing experience 3 years required.
• Discharge planning experience preferred.
• Managed Care experience 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.
• Ability to work independently and collaboratively in a remote, fast-paced environment.

Keywords: Talroo Health, nursing, discharge planning, managed care, case management, RN, nurse, health plan, health care, Monster, #ZipRecruiter

We provide market-competitive compensation packages, inclusive of base pay, incentives, benefits, and equity. The base pay rate for Full Time employment is:$66,830.40-$111,384.00

Benefits: Caring For Your Family and Your Career• 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.

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission “to improve health every day,” this is a tobacco-free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

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