Integrated Nurse Case Manager

City / State

Lexington, VA

Work Shift

First (Days)

Overview :

Sentara Health Plansis hiring an Integrated Nurse Case Manager / RN / Maternity / OBGYN for Lexington, Buena Vista, Millboro, Goshen, Warm Springs, McDowell and surrounding areas!

This is a full-time, work-from-homeposition that requires travel to conduct face-to-face home visits for low and high risk pregnant population / member's homes or other locations in Lexington, Buena Vista, Millboro, Goshen, Warm Springs, McDowell and surrounding areas!

Status : Full-time,permanent position (40 hours)

Standard working hours : 8am to 5pm EST, M-F

Location : Applicants must be reside in Lexi ngton, Buena Vista, Millboro, Goshen, Warm Springs, McDowell and surrounding areas!!

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 experience preferred

Experience working with low and high risk pregnant population / Maternity / OB / L&D / 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

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.

Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.

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.

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-89064

#Indeed

Talroo - Nursing

Care Coordination, Case Management, RN, Case Manager, Registered Nurse, BSN, ADN, Nursing, Managed Care, MCO, Health Plan, high-risk pregnant members, Maternity, OBGYN, Labor and Delivery, Mother and Baby, Postpartum, L&D, Lexington, Buena Vista, Millboro, Goshen, Warm Springs, McDowell

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.