Integrated Nurse Care Manager- Remote VA

Sentara Healthcare Inc; Richmond (VA); Remote; USD 60,000 - 100,000; Full time

Job summary

An established industry player is seeking a dedicated Integrated Nurse Case Manager to join their team in the Eastern Middle Peninsula region of Virginia. In this full-time role, you will provide essential case management services to high-risk members, focusing on optimizing health outcomes through proactive coordination and individualized care planning. Your responsibilities will include conducting clinical assessments, developing tailored care plans, and collaborating with various healthcare professionals to ensure comprehensive support for members with complex needs. If you are passionate about making a difference in the lives of individuals with chronic conditions, this opportunity is perfect for you.

Qualifications

• 3 years of nursing experience with a focus on case management.
• Ability to develop and revise care plans for complex member populations.

Responsibilities

• Conduct clinical assessments to manage member needs and care plans.
• Collaborate with interdisciplinary teams to ensure comprehensive care.

Skills

Case Management

Communication Skills

Critical Thinking

Organizational Skills

Flexibility and Adaptability

Education

Associates or Bachelors Degree in Nursing

Job description

Sentara Healthcare is currently hiring an Integrated Nurse Case Manager for the Eastern Middle Peninsula region of VA!

This is a Full Time position with day shift hours and great benefits!

The position requires travel to conduct face-to-face home visits in the member’s home within the Eastern Middle Peninsula region of VA, including but not limited to: Millers Tavern, Dunnsville, Tappahanock.

Applicants must reside in or near one of these locations to be considered for the role.

The Integrated Care Manager (ICM) is a Registered Nurse Clinician responsible for providing comprehensive case management services to a defined high-risk member population. This role focuses on supporting individuals with complex care needs and aims to optimize health outcomes through proactive coordination, care planning, and resource management across the care continuum.

Target Member Population Includes:

• High Emergency Room (ER) utilizers
• Recent hospital discharges
• Members diagnosed with heart failure, COPD, or diabetes
• Individuals with Developmental Disability (DD) waivers

Key Responsibilities:

• Perform telephonic and/or face-to-face clinical assessments to identify, evaluate, and manage member needs, including medical, behavioral health, social, and long-term care services
• Develop, monitor, evaluate, and revise individualized care plans tailored to member needs and health goals
• Identify members at risk for complications or re-hospitalizations and coordinate timely interventions with the member, caregiver, and health care team
• Support management of chronic illnesses, co-morbidities, and disabilities, ensuring appropriate utilization of benefits and adherence to care plans
• Conduct gap in care management as part of quality improvement initiatives
• Facilitate necessary authorizations and referrals within benefit guidelines or through extra-contractual arrangements when appropriate
• Collaborate with Medical Directors, Physician Advisors, and Interdisciplinary Teams to review and align on care plans and treatment recommendations
• Present member cases in case conferences to ensure a multidisciplinary approach to care
• Ensure all activities are compliant with regulatory standards, accreditation requirements, and company policies
• Assist in resolving provider, claims, or service-related issues impacting member care

Education

• Associates or Bachelors Degree in Nursing

Certification/Licensure

• Registered Nurse License (RN) - Nursing License - Compact/Multi-State License required.

Experience

• 3 years experience in Nursing
• Strong background in case management, including the ability to develop, monitor, and revise individualized care plans for complex member populations.
• Experience working with high-risk members, such as those with: Frequent ER utilization / Recent hospital discharges / Chronic conditions (e.g., heart failure, COPD, diabetes)/ Individuals with Developmental Disability (DD) waivers.
• Ability to collaborate with interdisciplinary teams, including physicians, social workers, and behavioral health professionals
• Excellent communication, critical thinking, and organizational skills
• Demonstrated flexibility and adaptability in a field-based role with travel requirements