Registered Nurse Case Manager

Sentara Healthcare Inc; Virginia Beach (VA); Remote; USD 70,000 - 95,000; Full time

Job summary

Sentara Health Plan is seeking a Full-Time RN Case Manager for the Commercial Complex Cases Integrated Care Management team. This is a remote position for candidates residing in Virginia or North Carolina. The role involves managing care plans and coordinating services to optimize member healthcare outcomes.

Qualifications

• 3 years of Case Management RN experience required.
• Experience in Complex Case Integrated Commercial Managed Care preferred.
• Familiarity with NCQA guidelines.

Responsibilities

• Develops and monitors care plans for members.
• Performs telephonic clinical assessments for member needs.
• Coordinates care with healthcare teams.

Skills

Case Management

Customer Engagement

Telephonic Clinical Assessments

Chronic Illness Management

Behavioral Health Knowledge

Education

RN diploma

BSN

Tools

JIVA

Epic

Job description

Sentara Health Plan is hiring a Full-Time Day-shift

RN 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 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 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

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