Integrated Care Manager, Registered Nurse (RN), LTSS Waiver Members, Medicaid

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🔥 9 minutes ago

⚔️ Virginia – Remote

⚔️ Virginia – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

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Sentara Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1890

⚕️ Healthcare Insurance

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

• 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 • Performs telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs • 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.

🎯 Requirements

• 3 years experience in Nursing REQUIRED • BLD - Bachelor's Level Degree in Nursing preferred • Registered Nurse (RN) License (Compact or Virginia) REQUIRED • Managed Care/ Health Plan/ Health Insurance experience highly preferred • Case Management experience preferred • Long-Term Services and Supports (LTSS) waiver and Home Health experience preferred • Behavioral Health experience is secondary.

🏖️ 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 • Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.