Integrated Nurse Case Manager

City / State

Lexington VA

Work Shift

First (Days)

Overview :

Sentara Health Plansis hiring an Integrated Nurse Case Manager / RN / Maternity / OBGYN for Lexington Buena Vista Millboro Goshen Warm Springs McDowell and surrounding areas!

This is a full-time work-from-homeposition that requires travel to conduct face-to-face home visits for low and high risk pregnant population / members homes or other locations in Lexington Buena Vista Millboro Goshen Warm Springs McDowell and surrounding areas!

Status : Full-timepermanent position (40 hours)

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

Location : Applicants must be reside in Lexi ngton Buena Vista Millboro Goshen Warm Springs McDowell and surrounding areas!!

Primary responsibilities include :

Responsible for case management services within the scope of licensure; develops monitors evaluates and revises the members care plan to meet the members 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 members 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.

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 preferred

Managed Care or Health Plan experience preferred

Experience working with low and high risk pregnant population / Maternity / OB / L&D / Mother Baby / Postpartum experience 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 servicesall 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 and use the following as your Keyword Search : JR-89064

#Indeed

Talroo - Nursing

Care Coordination Case Management RN Case Manager Registered Nurse BSN ADN Nursing Managed Care MCO Health Plan high-risk pregnant members Maternity OBGYN Labor and Delivery Mother and Baby Postpartum L&D Lexington Buena Vista Millboro Goshen Warm Springs McDowell

Benefits : Caring For Your Family and Your Career

Medical Dental Vision plans

Adoption Fertility and Surrogacy Reimbursement up to $10000

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 $5250 / year and discounted educational opportunities through Guild Education

Student Debt Pay Down $10000

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 ifestablished 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 30000-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.

Required Experience :

Manager

Key Skills

Project Portfolio Management,Motivational Interviewing,HIPAA,Computer Skills,Intake Experience,Lean Six Sigma,Conflict Management,Case Management,Team Management,Program Development,Social Work,Addiction Counseling

Employment Type : Full-Time

Experience : years

Vacancy : 1