Nurse Case Manager

Overview Sentara Health Plans is currently hiring an Integrated Nurse Case Manager in the Hampton and Newport News area of Virginia. This is a full-time position (40 hrs/wk) with a Day shift (8am-5pm). The position is remote but requires in-person face-to-face assessments multiple times throughout the week. Candidates must be able to travel frequently to complete in-person assessments. Location of assessments includes the Peninsula (Hampton, Newport News, Poquoson, Smithfield, Isle of Wight, Ivor, Gloucester/surrounding area) with potential travel to the Southside. Responsibilities 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 in-person 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 knowledge 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) Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its workforce. Diversity, inclusion, and belonging are guiding principles of the organization to ensure its workforce reflects the communities it serves. This is a tobacco-free environment in support of our mission to improve health every day. Remote work availability For positions 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