Integrated Case Manager Registered Nurse

Sentara Healthcare Inc; Virginia Beach, Northern (VA, KY); On-site; USD 65,000 - 90,000; Full time

Job summary

Sentara Health in Virginia Beach is seeking a Remote Integrated Case Manager to coordinate member care across the health continuum, performing assessments and developing care plans within licensure. You will identify high-risk members, manage chronic conditions, and collaborate with Medical Directors, physicians and care teams to optimize health outcomes while ensuring regulatory compliance.

Strong communication, problem-solving and analytical skills are essential for timely authorizations and

Qualifications

• Minimum knowledge, skills and abilities to care for patients' physical, psychological, socio-cultural, spiritual and cognitive needs.
• Associates degree required; BSN preferred.

Responsibilities

• Provide case management within licensure; develop and monitor member care plans.
• Perform telephonic and face-to-face assessments to identify and manage needs.
• Coordinate care with Medical Directors, physicians, and interdisciplinary teams.
• Facilitate authorizations/referrals within benefits or extra-contractual arrangements.
• Ensure compliance with regulatory and company policies.

Skills

Oral and written communication

Interpersonal skills

Problem-solving

Facilitation skills

Analytical skills

Education

Associates degree

BSN preferred

Job description

Sentara Health is looking to hire a Remote Integrated Case Manager.

Candidates must reside in the State of Virgina.

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 and face to face as needed 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.

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)
• BSN (preferred)

Certification:

• Registered Nurse (required)

Experience:

• 3 years of nursing experience (required)
• Managed care (preferred)
• Disease Management experience (preferred)

Keywords: Talroo- Health, Disease Management, Case Management, Managed Care, Discharge Planning