Nurse Case Manager
Company: Sentara
Location: Virginia Beach
Posted on: April 15, 2024
Job Description:
City/StateVirginia Beach, VAOverviewWork ShiftFirst (Days)
(United States of America)Sentara Health is currently hiring for an
Integrated Nurse Case Manager!$10,000 sign on Bonus available for
qualified applicants!This is a Full-Time position with Day shift
hours and great benefits!Position is fully remote.Required
Qualifications:
- RN License (Virginia)
- Associates or Bachelor's Degree in Nursing
- Minimum 3 years of experience working as a Registered
NursePreferred Qualifications:
- Experience in Case Management
- Experience in Managed Care for Commercial Lines of
BusinessPrimary responsibilities include:
- RN Clinician 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.Sentara Health Plans provides
health insurance coverage through a full suite of commercial
products including consumer-driven, employee-owned and
employer-sponsored plans, individual and family health plans,
employee assistance plans and plans serving Medicare and Medicaid
enrollees.With more than 30 years' experience in the insurance
business and 20 years' experience serving Medicaid populations, 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.Benefits: Sentara offers an attractive array of full-time
benefits to include Medical, Dental, Vision, Paid Time Off, Sick,
Tuition Reimbursement, a 401k/403B, 401a, Performance Plus Bonus,
Career Advancement Opportunities, Work Perks and more.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!Keywords: Care Coordination, Case Management, Human Services,
Community Health, Health Education, RN Case Manager, Registered
Nurse, BSN, ADN, Commerical Managed CareJob SummaryRN Clinician
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.
Requires an RN; BSN preferred
Demonstrates the minimum knowledge, skills and abilities to care
for the individualized needs of the patient to include physical,
psychological, socio-cultural, spiritual and cognitive needs as
well as functional abilities including the need for diversified use
of such practices. Requires strong oral, written and interpersonal
communication skills, problem-solving skills, facilitation skills,
and analytical skills.Qualifications:ALD - Associate's Level
Degree: Nursing, BLD - Bachelor's Level Degree, BLD - Bachelor's
Level Degree: NursingRegistered Nurse (RN) Single State - Nursing
License - North Carolina, Registered Nurse (RN) Single State -
Nursing License - Virginia Department of Health Professionals
(VADHP), Registered Nurse License (RN) - Nursing License -
Compact/Multi-State LicenseDischarge Planning, Managed Care,
NursingSkillsCommunication, Complex Problem Solving, Critical
Thinking, Judgment and Decision Making, Microsoft Office, Service
OrientationSentara Healthcare 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.Per Clinical Laboratory Improvement Amendments (CLIA), some
clinical environments require proof of education; these regulations
are posted at for further information. In an effort to expedite
this verification requirement, we encourage you to upload your
diploma or transcript at time of application.In support of our
mission "to improve health every day," this is a tobacco-free
environment.
Keywords: Sentara, Chesapeake , Nurse Case Manager, Executive , Virginia Beach, Virginia
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