City/State

Norfolk, VA

Work Shift

First (Days)

Overview:

Sentara Health Plans is hiring an Integrated Case Manager - Registered Nurse (RN) for LTSS/ Home Health in Culpeper, Warrenton, Fauquier, Catlett, Madison, Orange, Brightwood, Bealeton, Washington, Rappahannock County, Gordonsville, VA!

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

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

The position requires both in person/face-to-face assessments with remote/home office for the LTSS Waiver population in Culpeper, Warrenton, Fauquier, Catlett, Madison, Orange, Brightwood, Bealeton, Washington, Rappahannock County, Gordonsville, VA!

Location: Candidate must reside in Culpeper, Warrenton, Fauquier, Catlett, Madison, Orange, Brightwood, Bealeton, Washington, Rappahannock County, Gordonsville, VA.

Job responsibilities:

• 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.

Education:

• BLD - Bachelor's Level Degree preferred

Certification/Licensure:

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

Experience:

• 3 years experience in Nursing REQUIRED

• Managed Care/ Health Plan/ Health Insurance experience highly preferred

• Case Management experience preferred

• Long-Term Services and Supports (LTSS) waiver and Home Health experience preferred

• Behavioral Health experience is secondary

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-98551

Talroo – Health Plan

Keywords: Medicaid, Managed Care, Health Plan, Health Insurance, MCO, Integrated Case Manager, Registered Nurse, RN, Nursing, Culpeper, Warrenton, Fauquier, Catlett, Madison, Orange, Brightwood, Bealeton, Washington, Rappahannock County, Gordonsville, Virginia, VA, NOVA, Northern Virginia, Western, Virginia, Long-Term Services and Supports (LTSS), Waiver, Home Healt