Nurse Case Manager

City/State Richmond, VA Work Shift First (Days) Overview: Sentara Health Plans is currently hiring an Integrated Nurse Case Manager in Petersburg, Dinwiddie and Chester the area of Virginia Status: Full Time (40 hrs/wk) Shift: Day (8am-5pm) *Position is remote but does require in person face-to-face assessments multiple times throughout the week. Candidates must be able to travel frequently throughout the week to complete in person assessments. Location of assessments include: Petersburg, Dinwiddie and Chester area of 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 Preferred: Private duty nursing experience and knowledgeable with ventilators in a facility or home Education - Associates or Bachelors Degree in Nursing (Required) Certification/Licensure - Virginia or Compact RN License (Required) Experience - 3 years experience in Nursing (Required) - Experience in Private Duty Nursing or NICU or Experience working with Ventilators (Required) - Discharge planning experience (Preferred) - Managed Care experience (Preferred) Keywords: Care Coordination, Case Management, Human Services, Community Health, Health Education, RN Case Manager, Registered Nurse, BSN, ADN, Private Duty, Ventilator, LinkedIn, Talroo-Nursing Benefits: Caring For Your Family and Your Career • 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 ifestablished system and employee eligibility criteria is met. 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.