Develops and monitors care plans for low and high-risk pregnant populations through telephonic and face-to-face assessments. Coordinates care with multidisciplinary teams to optimize member health and ensure efficient utilization of health benefits.
Requirements summary
Requires a Registered Nurse (RN) license and at least 3 years of nursing experience. A Bachelor's degree in Nursing and experience in maternal health or managed care are preferred.
City/State Winchester, VA Work Shift First (Days) Overview
Sentara Health Plans is hiring an Integrated Nurse Case Manager/RN for Maternal Health/ Perinatal in Winchester, Shenandoah, Frederick, Rockingham, VA! The position requires both in-person face-to-face assessments and remote telephonic assessments for the low and high risk pregnant population (Maternal Health / Perinatal / OB-GYN /Labor and Delivery / Mother-Baby / Postpartum) in Winchester, Shenandoah, Frederick, Rockingham, VA and the surrounding areas.
Status
Full-time, permanent position (40 hours)
Standard working hours: 8am to 5pm
EST,
M-F
Location: Applicants must be reside in Winchester, Shenandoah, Frederick, Rockingham, VA, and the surrounding areas.
Primary responsibilities include: 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 or face-to-face 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. Ensures compliance with regulatory, accrediting and company policies and procedures May assist in problem solving with provider, claims or service issues.
Education
Bachelors
Degree in
Nursing preferred
Certification/Licensure:
Registered
Nurse (RN)
License (Compact or
Virginia)
Required
Experience: 3 years experience in Nursing REQUIRED Case Management experience preferred Managed Care or Health Plan experience preferred Experience working with low and high risk pregnant population (Maternal Health / Perinatal / OB-GYN /Labor and Delivery / Mother-Baby / Postpartum) 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 Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees. Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals. We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health. Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth. Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve! To apply, please go to www.sentaracareers.com and use the following as your
Keyword
Search: JR-99149 Talroo - Nursing Care Coordination, Case Management, RN, Case Manager, Registered Nurse, BSN, ADN, Nursing, Managed Care, MCO, Health Plan, high-risk pregnant members, Maternal Health / Perinatal / OB-GYN /Labor and Delivery / Mother-Baby / Postpartum, Maternity, L&D,
Winchester,
Shenandoah,
Frederick,
Rockingham,
VA,
Virginia
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
Benefits
Dental Insurance
Life Insurance
Sick Leave
Paid Time Off
Vision Insurance
Medical Insurance
Short-Term Disability
Long-Term Disability
Pet Insurance
Critical Illness Plans
Tuition Assistance
Certification Reimbursement
Paid Parental & Family Caregiver Leave
Emergency Backup Care
401k/403B with Employer Match
Student Debt Pay Down
Legal Resources Plan
Annual Discretionary Bonus
Adoption, Fertility and Surrogacy Reimbursement
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 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!
