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Integrated Nurse Case Manager/RN- Norfolk, VA Beach, Suffolk, Chesapeake, Portsmouth, Williamsburg and Newport News, VA!

Sentara
paid time off, tuition reimbursement, 401(k), 403(b)
United States, Virginia, Roanoke
Feb 27, 2025
City/State Virginia Beach, VA Overview Work Shift First (Days) (United States of America) Sentara Health Plansis hiring an Integrated Nurse Case Manager/RNfor the Tidewater region: Norfolk, VA Beach, Suffolk, Chesapeake, Portsmouth, Williamsburg and Newport News, VA! Sign-on bonus offer to qualified applicants! The position requires both in-person face-to-face assessments and remote telephonic assessments. Status: Full-time,permanent position (40 hours) Standard working hours: 8am to 5pm EST, M-F Location: Applicants must reside in the Tidewater region: Norfolk, VA Beach, Suffolk, Chesapeake, Portsmouth, Williamsburg and Newport News, VA! 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. Required qualifications: Registered Nurse (RN) License (Compact or Virginia) REQUIRED Associate or Bachelors Degree in Nursing REQUIRED 3 years experience in Nursing REQUIRED Preferred qualifications: Case Management experience preferred Discharge planning experience preferred Managed Care or Health Plan experience preferred Sentara Health Plans is the health insurance division of Sentara Healthcare. 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! To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-72297 Talroo - Nursing Care Coordination, Case Management, RN, Case Manager, Registered Nurse, BSN, ADN, Nursing, Norfolk, VA Beach, Suffolk, Chesapeake, Portsmouth, Tidewater, Managed Care, MCO, Health Plan Job Summary Case Manager coordinates the care and services of selected member populations across the continuum of care, promotes effective utilization and monitoring of health care resources, and assumes a collaborative role with all members of the healthcare team to achieve optimal clinical and resource outcomes. Case Manager must be able to effectively assess and coordinate members needs; maximize their available benefits; assist in creating a cost effective plan of care; and identify high risk and high utilization cases. Assigned cases may include components of medical, behavioral health, disease management, complex case management, and/or concurrent (Utilization Review) review. Bachelor's degree must be in Nursing or a Bachelor's prepared Licensed Behavioral Health Clinician for community based case management teams required. 3 years of related experience can be in one of the following areas, acute care nursing, case management, UR/UM, discharge planning, clinical psychiatric setting, disease management, hospice/home health or community/public health. Licensed in accordance with profession discipline required. ACM, CCM, CMCC or RN-BC is required upon hire or within 1 year of eligibility. Qualifications: BLD - Bachelor's Level Degree (Required) Discharge Planning, Managed Care, Nursing Skills Communication, Microsoft Office, Speaking, Writing Sentara 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 ecfr.gov 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.