Integrated Nurse Case Manager

Sentara Healthcare Inc; Roanoke (VA); Remote; USD 60,000 - 90,000; Full time

Job summary

An established industry player is seeking a dedicated Nurse Case Manager to join their Health Care Services Department. This remote role requires travel to Nursing Facilities and Members' Homes in the Roanoke area. You will play a crucial role in developing and implementing personalized care plans, conducting clinical assessments, and coordinating care for high-risk members. If you have a strong nursing background and excellent communication skills, this opportunity allows you to make a significant impact on patient care while working independently in a dynamic environment. Join a team committed to improving the health and well-being of the community.

Qualifications

• 3+ years of nursing experience required, with strong communication and problem-solving skills.
• RN License in Virginia/Compact is mandatory.

Responsibilities

• Develop individualized care plans and perform clinical assessments for members.
• Coordinate care for high-risk members and manage cost-effective health benefits.

Skills

Communication Skills

Problem-Solving Skills

Analytical Skills

Nursing Experience

Knowledge of Patient Needs

Education

Associate or Bachelor’s Degree in Nursing

Job description

Sentara Health Plans is hiring a Nurse Case Manager for the Health Care Services Department.

This is a remote position; however, traveling to Nursing Facilities and Members' Homes is required in Roanoke and surrounding areas in Virginia.

Key Responsibilities:

• Develop and implement individualized care plans for members to address their physical, behavioral, social, and long-term care needs.
• Perform face-to-face clinical assessments to identify, evaluate, and manage members’ needs.
• Coordinate care for high-risk members, including those with chronic conditions, co-morbidities, or disabilities.
• Manage care to ensure cost-effective and efficient utilization of health benefits, including conducting gap-in-care management for quality programs.
• Facilitate authorizations, referrals, and care plan implementation within benefits and coverage structures.
• Work closely with Medical Directors, Physician Advisors, and Interdisciplinary Teams to present and discuss case management treatment plans.
• Ensure compliance with regulatory, accrediting, and company policies and procedures.
• Assist with problem-solving related to provider, claims, or service issues as needed.

Education:

• Associate or bachelor’s degree in nursing.

Certification:

• RN License (Virginia/Compact).

Experience:

• Nursing experience: 3 years required.
• Discharge planning experience preferred.
• Managed Care experience preferred.
• Strong knowledge of physical, psychological, socio-cultural, and cognitive patient needs.
• Excellent communication skills, both oral and written, as well as strong problem-solving and analytical skills.
• Ability to work independently and collaboratively in a remote, fast-paced environment.