Nurse Case Manager

Overview

Sentara Health Plans is currently hiring an Integrated Nurse Case Manager in the Central-Midlothian area of Virginia. Status:
Full Time (40 hrs/wk). Shift: Day (8am-5pm). Position is remote but requires 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 around the central region.

• Case management services within the scope of licensure; develop, monitor, evaluate, and revise member's care plan.
• Perform 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.
• Identify members for high‑risk complications and coordinate care with the member and health‑care team.
• Manage chronic illnesses, co‑morbidities, and/or disabilities ensuring cost‑effective and efficient utilization of health benefits; conduct gap‑in‑care management for quality programs.
• Assist with the implementation of member care plans by facilitating authorizations/referrals within benefits structure or extra‑contractual arrangements, as permissible.
• Interface with Medical Directors, Physician Advisors, and/or Inter‑Disciplinary Teams on care‑management treatment plans.
• Present cases at case conferences for multidisciplinary focus.
• Ensure compliance with regulatory, accrediting and company policies and procedures.
• Assist in problem solving with provider, claims or service issues.

• Associate’s or Bachelor’s Degree in Nursing (Required).
• Virginia or Compact RN License (Required).
• 3 years experience in Nursing (Required).
• Experience in Private Duty Nursing, NICU or working with ventilators (Required).
• Discharge planning experience (Preferred).
• Managed Care experience (Preferred).
• Private duty nursing experience and knowledge of ventilators in a facility or home (Preferred).

• 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
• 401(k)/403(b) 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
• Annual discretionary bonus opportunity based on system and employee eligibility criteria.

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its workforce.