The Nurse Case Manager is responsible for case management services, developing and revising care plans to optimize member health care. They perform clinical assessments and coordinate care for members with complex needs, ensuring compliance with policies and regulations.
Requirements summary
Candidates must have an Associate's or Bachelor's Degree in Nursing and a Virginia or Compact RN License. A minimum of 3 years of nursing experience, preferably in private duty nursing or NICU, is required.
City/State Newport News, VA Work Shift First (Days) Overview
Sentara Health Plans is currently hiring an Integrated
Nurse
Case
Manager in the
Central-
Midlothian area of
Virginia
Status:
Full
Time (40 hrs/wk)
Shift: Day (8am-5pm) *Position is remote but does require in person face-to-face assessments multiple times throughout the week. Candidates must be able to travel frequently throughout the week to complete in person assessments around the central region
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
Preferred: Private duty nursing experience and knowledgeable with ventilators in a facility or home Education Associates or Bachelors Degree in Nursing (Required) Certification/Licensure Virginia or Compact RN License (Required) Experience 3 years experience in Nursing (Required) Experience in Private Duty Nursing or NICU or Experience working with Ventilators (Required) Discharge planning experience (Preferred)
Managed
Care experience (Preferred)
Keywords: Care Coordination, Case Management, Human Services, Community Health, Health Education, RN Case Manager, Registered Nurse,
Benefits
Life Insurance
Medical
Dental
Vision Plans
Pet Insurance
Adoption
Paid Parental & Family Caregiver Leave
Emergency Backup Care
401k/403B with Employer Match
Legal Resources Plan
Paid Time Off and Sick Leave
Annual Discretionary Bonus
Student Debt Pay Down – $10,000
Fertility and Surrogacy Reimbursement up to $10,000
Long-Term, Short-Term Disability, and Critical Illness Plans
Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
Reimbursement for Certifications and Free Access to Complete CEUs and Professional Development
BSN,
ADN,
Private
Duty,
Ventilator,
LinkedIn,
Talroo-Nursing
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 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!
