[Hiring] Integrated Nurse Case Manager/Registered Nurse/RN for Chronic/Complex Condition @Sentara Health

Role Description

Sentara Health Plans is hiring an Integrated Nurse Case Manager/Registered Nurse/RN for Chronic/Complex Condition in Hampton, Newport News, Yorktown, Williamsburg, VA, and the surrounding areas!

This is a full-time, work-from-home position that requires travel to conduct face-to-face home visits (target of at least 12 monthly) for chronic/complex condition members (asthma, diabetes, heart failure, cancer, heart disease, COPD).

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

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

Location: Applicants must reside in Hampton, Newport News, Yorktown, Williamsburg, VA, and the surrounding areas!

• 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.

Target Member Population Includes:

• High Emergency Room (ER) utilizers
• Recent hospital discharges
• Members diagnosed with chronic/complex conditions (Asthma, diabetes, heart failure, cancer, heart disease, COPD)

Qualifications

• Associate or Bachelors Degree in Nursing - REQUIRED
• Registered Nurse (RN) License (Compact or Virginia) - REQUIRED

Requirements

• 3 years experience in Nursing - REQUIRED
• Case Management experience - highly preferred
• Managed Care or Health Plan experience - preferred
• Experience working with chronic/complex condition members (Asthma, diabetes, heart failure, cancer, heart disease, COPD) - preferred
• Experience in home health experience, inpatient case management, hospice, transition of care, and discharge planning - 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

• 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.