Nurse Case Manager

Sentara Health Plans is currently hiring an Integrated Nurse Case Manager in Tidewater Virginia

Status: Full Time (40 hrs/wk)

Shift: Day (8am-5pm)

Location: Remote
* in Tidewater, VA (Requires Travel)

* Position is remote but does require in person face-to-face assessments multiple times throughout the week. Candidates must be able to travel frequently throughout the week to complete in person assessments.

Location of assessments include
:
Peninsula including Hampton, Newport News, Poquoson, Smithfield, Isle of White, Ivor, Gloucester/surrounding area, with potential to travel to the Southside

• 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

Private duty nursing experience and knowledgeable with ventilators in a facility or home

• Associates or Bachelors Degree in Nursing (Required)

• Virginia or Compact RN License (Required)

• 3 years experience in Nursing (Required)
• Experience in Private Duty Nursing or NICU or Experience working with Ventilators (Required)
• Discharge planning experience (Preferred)
• Managed Care experience (Preferred)