Integrated RN Care Manager

City/State

Work Shift

Overview:

This is aFull-Timeposition with day shift hours and great benefits!

The position requires both in-person face-to-face assessments and remote telephonic assessments in and around Virginia Beach, Norfolk, and surrounding communities.

*Applicants must reside within driving distance.

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: LTSS, Medicaid, waiver population case management experience, and knowledge of DMAS and Epic

• Associate's or Bachelors Degree in Nursing

• Registered Nurse License (RN) - Nursing License - Compact/Multi-State License required.

• 3 years experience in Nursing

• Discharge planning experience preferred

• Managed Care experience preferred

• Preferred: LTSS, Medicaid, waiver population case management experience, and knowledge of DMAS and Epic

Keywords: Care Coordination, Case Management, Human Services, Community Health, Health Education, RN Case Manager, Registered Nurse, BSN, LinkedIn, Monster, Talroo-Nursing, Cardinal, Medicaid, DMAS, MCO, managed care, LTSS, long-term services support, transition of care, discharge planning, community outreach

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.