[Hiring] Integrated Nurse Case Manager/RN for Maternal Health/Perinatal @Sentara Health

Role Description

Sentara Health Plans is hiring an Integrated Nurse Case Manager/RN for Maternal Health/Perinatal for Roanoke, Christiansburg, Blacksburg, Radford, Pulaski, Giles, Salem, VA (South of Roanoke). The position requires both telephonic and face-to-face assessments and remote telephonic assessments for the low-risk and high-risk pregnant population.

• 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.
• Performs telephonic or face-to-face clinical assessments for the identification, evaluation, coordination, and management of member's needs.
• 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.
• 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.

Qualifications

• Associate or Bachelor's Degree in Nursing (REQUIRED)
• Registered Nurse (RN) License (Compact or Virginia) (REQUIRED)
• 3 years experience in Nursing (REQUIRED)
• Case Management experience (preferred)
• Managed Care or Health Plan or Medicaid experience (preferred)
• Experience working with low and high-risk pregnant population (Maternal Health / Perinatal / OB-GYN / Labor and Delivery / Mother-Baby / Postpartum) (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.