Registered Nurse Case Manager

Davita Inc.; Virginia Beach (VA); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare provider is seeking a Full-Time RN Case Manager for remote work within Virginia or North Carolina. The ideal candidate will be responsible for case management services, emphasizing telephonic assessments and member care coordination. This role offers a competitive salary and a comprehensive benefits package including medical, dental, and tuition assistance.

Benefits

Medical, Dental, Vision plans

401k/403B with Employer Match

Tuition Assistance - $5,250/year

Paid Time Off and Sick Leave

Adoption, Fertility and Surrogacy Reimbursement up to $10,000

Qualifications

• Registered Nurse diploma required.
• 3 years of Case Management RN experience preferred.
• Valid RN license necessary.

Responsibilities

• Develops and revises member's care plans for optimization.
• Performs clinical assessments and manages chronic illnesses.
• Coordinates care with the health care team and conducts case conferences.

Skills

Case Management

Telephonic Assessments

Health Coordination

Education

RN diploma

BSN

Tools

JIVA

Epic

NCQA Guidelines

Job description

City/State

Virginia Beach, VA

Work Shift

First (Days)

Overview:

Sentara Health Plan is hiring a Full-Time Day-shiftRN Case Manager for the Commercial Complex Cases Integrated Care Management team

This is a remote, telephonic position however, candidates must reside in Virginia or North Carolina.

• 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 andmanagement 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 andefficient 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 arrangement 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.

Sentara Health Plans is the health insurance division of Sentara Health.
Sentara Health Plans provides health insurance coverage through a full suite of commercial products

Education

• RN diploma required
• BSN preferred

Certification/Licensure

• Valid RN license

Experience

• 3 years of Case Management RN experience required, Complex Case Integrated Commercial Managed Care and discharge planning preferred.
• Experience with JIVA and Epic experience preferred.
• Proficient with NCQA guidelines

keywords: LinkedIn, Case Management, RN, Registered Nurse, BSN, Talroo-Nursing, Monster, care coordinator, ACM, CCM, TCM, CMAC or CGMT-BC, MCG, Comercial health plan payors, Managed Care, JIVA, Epic, QNXT, NCQA, member engagement, discharge planning, oncology, ESRD, transplant, Autoimmune, Behavioral health, integrated care, complex cases

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

* Reimbursement for certifications and free access to complete CEUs and professional development

*Pet Insurance
*Legal Resources Plan
*Colleagues have the opportunity to earn an annual discretionary bonus ifestablished 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.