Integrated Case Manager

Sentara Health Plans; Harrisonburg (VA); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

Paid Time Off

Sick Leave

Paid Parental & Family Caregiver Leave

401k/403B with Employer Match

Tuition Assistance

Employee Wellness Programs

Life Insurance

Job summary

Sentara Health Plans in Harrisonburg, VA, is seeking an Integrated Case Manager, RN to support members who are medically and behaviorally complex. This role blends in-person assessments with remote telephonic reviews to coordinate care across physical and behavioral health, social services, and long-term supports.

You will develop and monitor care plans, partner with Medical Directors and care teams, identify high-risk members, and facilitate authorizations/referrals within benefits.

Qualifications

• Associates degree required.
• Bachelor's degree preferred.
• Registered Nurse license required.
• Minimum 3 years nursing experience.
• Managed care and discharge planning experience preferred.

Responsibilities

• Perform telephonic and face-to-face clinical assessments to manage member needs.
• Develop, monitor and revise member care plans across physical and behavioral health.
• Coordinate authorizations/referrals within benefits structure.
• Collaborate with Medical Directors and care teams.
• Identify high-risk members and optimize health care utilization.

Skills

Interpersonal communication

Problem solving

Analytical skills

Education

Associates

Bachelors

Job description

City/State Harrisonburg, VA

Work Shift First (Days)

Overview: Sentara Health in Harrisonburg VA is looking to hire an Integrated Case Manager, RN. This position will work with members under Sentara Health Plans who are both medically and behaviorally complex. This position requires both in-person/face-to-face assessments and remote telephonic assessments for members with Serious Mental Illnesses, Serious Emotional Disturbances (ages 2+) and Substance Abuse Disorders!

Location: Applicants must be in Harrisonburg, area VA. Travel may include up to 90 minutes one way.

The Integrated Case Manager is 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. Ensure compliance with regulatory, accrediting and company policies and procedures. May assist in problem solving with provider, claims or service issues. Demonstrates the minimum knowledge, skills and abilities to care for the individualized needs of the patient to include physical, psychological, socio-cultural, spiritual and cognitive needs as well as functional abilities including the need for diversified use of such practices. Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Education

• Associates (required)
• Bachelors (preferred)

Certification

• Registered Nurse (required)

Experience

• 3 years of nursing experience (required)
• Managed care (preferred)
• Discharge planning experience (preferred)

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
• 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.

Sentara Health is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering hundreds of sites of care including 12 hospitals, PACE, home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan. The people of the communities that we serve have nominated Sentara "Employer of Choice" for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy!