Integrated Nurse Case Manager, Registered Nurse, RN – Chronic/Complex Condition

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🕒 2 days ago

⚔️ Virginia – Remote

⚔️ Virginia – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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Sentara Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1890

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

Sentara Health is a leading healthcare system that operates over 300 sites of care in Virginia and northeastern North Carolina, including 12 acute care hospitals. The company is dedicated to providing exceptional patient care, fostering professional development, and maintaining a diverse workforce. Sentara Health aims to improve health every day and has been recognized for its clinical and operational performance, being named one of the top 15 health systems by IBM Watson Health. The organization supports its employees in achieving their full potential and encourages growth and innovation in the healthcare sector.

📋 Description

• Provide case management services within the scope of licensure • Develop, monitor, evaluate, and revise member care plans to optimize healthcare across the care continuum • Perform telephonic and face-to-face clinical assessments • Identify, evaluate, coordinate, and manage members’ physical, behavioral, social-service, and long-term-service needs • Identify members at risk for complications and coordinate care with members and healthcare teams • Manage chronic illnesses, comorbidities, and disabilities for cost-effective utilization of health benefits • Conduct gap-in-care management for quality programs • Facilitate authorizations and referrals within the benefits structure or permissible extra-contractual arrangements • Interface with Medical Directors, Physician Advisors, and interdisciplinary teams on care-management treatment plans • Present cases at multidisciplinary case conferences • Ensure compliance with regulatory, accrediting, and company policies and procedures • Assist with provider, claims, or service-issue problem solving • Conduct face-to-face home visits, targeting at least 12 monthly

🎯 Requirements

• Associate or Bachelor’s Degree in Nursing required • Registered Nurse (RN) License, Compact or Virginia, required • 3 years of nursing experience required • Case Management experience highly preferred • Managed Care or Health Plan experience preferred • Experience working with chronic/complex condition members preferred • Home health, inpatient case management, hospice, transition of care, and discharge planning experience preferred • Strong knowledge of physical, psychological, socio-cultural, and cognitive patient needs • Excellent oral and written communication skills • Strong problem-solving and analytical skills • Must reside in Hampton, Newport News, Yorktown, Williamsburg, Virginia, or surrounding areas • Ability to work 8 a.m. to 5 p.m. EST, Monday through Friday • Ability to travel for face-to-face home visits

🏖️ Benefits

• 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 • Annual discretionary bonus if established system and employee eligibility criteria is met • Work-from-home position • Professional development and a continued employment philosophy