Integrated Case Manager

Sentara Health Plan 9R; Harrisonburg (VA); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

401k/403B with Employer Match

Tuition Assistance

Paid Time Off

Job summary

Sentara Health Plan 9R in Harrisonburg, VA is seeking an Integrated Case Manager, RN to coordinate care for members with complex medical and behavioral needs. The role combines in-person assessments with remote telephonic evaluations to develop and monitor individualized care plans across the care continuum.

You will collaborate with Medical Directors and interdisciplinary teams, identify high‑risk patients, manage chronic conditions, facilitate authorizations/referrals, support discharge

Qualifications

• Associates degree is required.
• Registered Nurse licensure is required.
• Minimum 3 years of nursing experience is required.
• Managed care and discharge planning experience are preferred.

Responsibilities

• Perform in-person or telephonic clinical assessments to identify member needs.
• Develop, monitor, and revise member care plans across physical, behavioral and social needs.
• Coordinate care with health team, authorize referrals within benefits or contracts.
• Interface with Medical Directors and Interdisciplinary Teams on treatment plans.
• Present cases at case conferences for multidisciplinary input and ensure regulatory compliance.
• Assist with problem solving with providers, claims or service issues.

Skills

Nursing

Communication

Problem-solving

Facilitation

Analytical skills

Education

Associate degree

Bachelor's degree (preferred)

Job description

City/StateHarrisonburg, VAWork ShiftFirst (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 skillsEducation:· Associates (required)· Bachelors (preferred)Certification:· Registered Nurse (required)Experience:· 3 years of nursing experience (required)· Managed care (preferred)· Discharge planning experience (preferred)Keywords: Talroo- Health, Case Management, Managed Care, Discharge PlanningBenefits: 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.