Integrated Nurse Case Manager/Registered Nurse (RN) for Maternal Health/ Perinatal in Central R[...]

Overview: Sentara Health Plans is hiring an Integrated Nurse Case Manager/RN for Maternal Health/ Perinatal for Central Richmond (Henrico, Hanover, Colonial Heights, VA) and the surrounding areas! The position requires both telephonic and face-to-face assessments and remote telephonic assessments for the low-risk and high-risk pregnant population (Maternal Health / Perinatal / OB-GYN /Labor and Delivery / Mother-Baby / Postpartum) in Central Richmond (Henrico, Hanover, Colonial Heights, VA) and the surrounding areas. Status: Full-time, permanent position (40 hours) Standard working hours: 8am to 5pm EST, M-F City/State Richmond, VA Work Shift First (Days) 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 Education: Associate or Bachelors Degree in Nursing REQUIRED Certification/Licensure: Registered Nurse (RN) License (Compact or Virginia) REQUIRED Experience: 3 years experience in Nursing REQUIRED Case Management experience preferred Managed Care or Health Plan or Medicaid experience preferred Experience working with low and high risk pregnant population (Maternal Health / Perinatal / OB-GYN / Labor and Delivery / Mother-Baby / Postpartum) experience preferred Strong knowledge of physical, psychological, socio-cultural, and cognitive patient needs. Excellent communication skills, both oral and written, as well as strong problem-solving and analytical skills 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 if established 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. #J-18808-Ljbffr Sentara Health