NURSE CASE MGR

Sentara
US - Virginia - Virginia Beach
January 16, 2025

City/State
Richmond, VA

Overview
Work Shift
First (Days) (United States of America)

Sentara Health Plans is hiring a Nurse Case Manager for the Health Care Services Department.
This is a remote position however traveling is required twice a week in TW area VA Beach/Norfolk, Central and its surroundings in Virginia.
The Nurse Case Manager is 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.
Nurse Case Managers manage 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.
Nurse Case Manager 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.
Job Requirements:

RN License (Virginia/Compact)
Associate or bachelor's degree in nursing
Nursing experience 3 years required
Discharge planning experience preferred
Managed Care experience preferred
Benefits :
Sentara offers an attractive array of full-time benefits to include Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B, 401a, Performance Plus Bonus, Career Advancement Opportunities, Work Perks and more.
Sentara employees strive to make our communities healthier places to live.
We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace.
For more information about our employee benefits, ***/explore-sentara/benefits/
Join our team, where we are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, growth!
Keywords:
Talroo Health, nursing, discharge planning, managed care, case management, RN, nurse, health plan, health care, #Indeed, Monster
Job Summary
RN Clinician 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.
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.
Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on care management treatment plans.

Requires an RN; BSN preferred
Demonstrates the minimum knowledge, skills and abilities to care for the individualized needs of the patient to include physical, psychological, socio-cultural, spiritual and cognitive needs as well as functional abilities including the need for diversified use of such practices.
Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills

Qualifications:

ALD - Associate's Level Degree:
Nursing, BLD - Bachelor's Level Degree, BLD - Bachelor's Level Degree:
Nursing Registered Nurse (RN) Single State - Nursing License - North Carolina, Registered Nurse (RN) Single State - Nursing License - Virginia Department of Health Professionals (VADHP), Registered Nurse License (RN) - Nursing License - Compact/Multi-State License Discharge Planning, Managed Care, Nursing

Skills
Communication, Complex Problem Solving, Critical Thinking, Judgment and Decision Making, Microsoft Office, Service Orientation

Sentara Healthcare 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.
Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information.
In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.

In support of our mission "to improve health every day," this is a tobacco-free environment.

Read the full job description and apply online on the recuiter's web-site

Related Job Postings

RN Registered Nurse - PACU 10am - 9pm

Sentara Health

US - VA - VA - Virginia Beach
January 15, 2025

City/State • Virginia Beach, VA • OverviewWork Shift • First (Days) (United States of America) • Sentara Princess Anne Hospital, located in Virginia Beach, Virginia, is hiring a FULL TIME RN (Registered Nurse) to join our Post Anesthesia Care Unit (PACU) Team. • Up to $15,000 Sign On Bonus to...

Find Jobs Hiring Now Near You!

Get Jobilize Job Search Mobile App Now