Nurse Case Manager - Winchester, VA

Company: Sentara
Location: Virginia Beach
Posted on: March 16, 2023

Job Description:

City/StateWoodbridge, VAOverviewWork ShiftFirst (Days) (United States of America)Sentara Health Plansis hiring an Integrated Nurse Case ManagerIn the Northern Virginia area! Sign on Bonus Available for qualified applicants!This is a Full Time position with Day shift hours and great benefits!Position requires both in person face-to-face assessments and remote telephonic assessments!Applicants must be located in Northern Virginia Regionarea includes: Winchester, Fairfax, Culpper, Manassas, Arlington, Luray, Front Royal, Leesburg and surrounding areas!Job Requirements:

• RN License (Virginia)
• Associates or Bachelors Degree in Nursing
• 3 years experience in Nursing
• Case Management experience preferred
• Discharge planning experience preferred
• Managed Care experience preferredPrimary 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.Sentara Health Plans is the health insurance division of Sentara Healthcare doing business as Optima Health and Virginia Premier.Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees.With more than 30 years' experience in the insurance business and 20 years' experience serving Medicaid populations, 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.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.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!Keywords: Indeed, Monster, Talroo- Health Plan, Care Coordination, Case Management, Human Services, Community Health, Health Education, RN Case Manager, Registered Nurse, BSN, ADN, Discharge Planning, Long Term CareJob SummaryRN 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. 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.
    
    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 skillsQualifications:ALD - Associate's Level Degree: Nursing, BLD - Bachelor's Level Degree, BLD - Bachelor's Level Degree: NursingRegistered Nurse License (RN) - Compact/Multi-State License, Registered Nurse License (RN) - North Carolina, Registered Nurse License (RN) - VirginiaDischarge Planning, Managed Care, NursingSkillsCommunication, Complex Problem Solving, Critical Thinking, Judgment and Decision Making, Microsoft Office, Service OrientationSentara 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.

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