Integrated Case Manager- RN

Sentara Health Plans; Richmond, Northern (VA, KY); Hybrid; USD 85,000 - 105,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

Tuition Assistance – $5,250/year

401k/403B with Employer Match

Paid Time Off

Disability plans

Life Insurance

Job summary

Sentara Health Plans seeks an Integrated Case Manager (RN) to coordinate and oversee patient care across the health continuum. The role involves telephonic assessments, care plan development, and collaboration with physicians and care teams.

Travel to Winchester, Leesburg, Alexandria, Arlington, Manassas, Warrenton, Front Royal, and Harrisonburg is required. Remote work is possible with in-person assessments.

Qualifications

• Assists with care plan development, monitoring, and revision.
• Performs telephonic clinical assessments for needs across physical, behavioral health, and social services.
• Collaborates with medical directors and interdisciplinary teams for care plans.

Responsibilities

• Develop, monitor, and revise member care plans to optimize health across the continuum.
• Identify high-risk members and coordinate care with the health team.
• Manage chronic illnesses and ensure cost-effective utilization of benefits.

Skills

Telephonic assessments

Case management

Nursing

Travel to multiple locations

Communication skills

Analytical skills

Education

Associates degree

Bachelor's degree

Job description

City/State: Richmond, VA

Work Shift: First (Days)

Sentara Health is looking to hire an Integrated Case Manager, RN.

Status: Full Time (40 hrs/wk)

Shift: Day (8am-5pm)

This Position is remote but does require in person face-to-face assessments.

Candidates must be able to travel to Winchester, Leesburg, Alexandria, Arlington, Manassas, Warrenton, Front Royal, Harrisonburg, VA.

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 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 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!