Nurse Case Manager

City / State

Virginia Beach, VA

Work Shift

First (Days)

Overview :

Sentara Health Plans is currently hiring an Integrated Nurse Case Manager in Tidewater Virginia

Status : Full Time (40 hrs / wk)

Shift : Day (8am-5pm)

Location : Remote in Tidewater, VA (Requires Travel)

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

Peninsula including Hampton, Newport News, Poquoson, Smithfield, Isle of White, Ivor, Gloucester / surrounding area, with potential to travel to the Southside

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

Certification / Licensure

Experience

Benefits : Caring For Your Family and Your Career

Medical, Dental, Vision plans

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.