About the job
City/State
Virginia Beach, VA
Work Shift
First (Days)
Overview:
Sentara Health Plan is hiring a Full-Time Day-shift
RN Case Manager for the Commercial Complex Cases Integrated Care Management team
This is a remote, telephonic position however, candidates must reside in Virginia or North Carolina.
- 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 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 arrangement 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 Health.
Sentara Health Plans provides health insurance coverage through a full suite of commercial products
Education
- RN diploma required
- BSN preferred
Certification/Licensure
- Valid RN license
Experience
- 3 years of Case Management RN experience required, Complex Case Integrated Commercial Managed Care and discharge planning preferred.
- Experience with JIVA and Epic experience preferred.
- Proficient with NCQA guidelines
keywords: LinkedIn, Case Management, RN, Registered Nurse, BSN, Talroo-Nursing, Monster, care coordinator, ACM, CCM, TCM, CMAC or CGMT-BC, MCG, Comercial health plan payors, Managed Care, JIVA, Epic, QNXT, NCQA, member engagement, discharge planning, oncology, ESRD, transplant, Autoimmune, Behavioral health, integrated care, complex cases
Benefits: Caring For Your Family and Your Career
- 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.
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.