Integrated Nurse Case Manager/Registered Nurse/RN for Chronic/Complex Condition in Fredericksburg, Spotsylvania, VA

City/State

Work Shift

Overview:

Sentara Health Plans is hiring an Integrated Nurse Case Manager/Registered Nurse/RN for Chronic/Complex Condition in Fredericksburg, Spotsylvania, VA, and the surrounding areas!

This is a full-time, work-from-home position that requires travel to conduct face-to-face home visits (approx 2-3 times a week) for chronic/complex condition members (asthma, diabetes, heart failure, cancer, heart disease, COPD) Fredericksburg, Spotsylvania, VA, and the surrounding areas!

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

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

Location: Applicants must reside in Fredericksburg, Spotsylvania, VA and the surrounding areas!

Primary 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.

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)

Education:

• Associate or Bachelors Degree in Nursing REQUIRED

Certification/Licensure:

• Registered Nurse (RN) License (Compact or Virginia) REQUIRED

Experience:

• 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

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.

Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.

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.

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!

To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-104113

Talroo – Health Plan

Managed Care, MCO, Health Plan, Healthcare, Health Insurance, Nursing, RN, Registered Nurse, Medicaid, Chronic, Complex condition members, Asthma, diabetes, heart failure, cancer, heart disease, COPD, home health experience, inpatient case management, hospice, emergency room, ED, Emergency Department, Discharge Planning, Case Management, Transition of Care, TOC, Virginia Fredericksburg, Spotsylvania, VA, Remote, Virginia

Sentara Health is an equal opportunity employer and 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.

In support of our mission “to improve health every day,” this is a tobacco-free environment.

For positions that are available as remote work,Sentara Health employs associates in the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.