City/State

Richmond, VA

Work Shift

First (Days)

Overview:

Sentara Health Plans is hiring an Integrated Nurse Case Manager/RN for Maternal Health/ Perinatal for Central Richmond (Henrico, Hanover, Colonial Heights, VA and the surrounding areas)!

 

The position requires both telephonic and face-to-face assessments and remote telephonic assessments for the low-risk and high-risk pregnant population (Maternal Health / Perinatal / OB-GYN /Labor and Delivery / Mother-Baby / Postpartum) in Central Richmond (Henrico, Hanover, Colonial Heights, 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 Central Richmond (Henrico, Hanover, Colonial Heights, 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.

 

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 or Medicaid experience preferred

• Experience working with low and high risk pregnant population (Maternal Health / Perinatal / OB-GYN /Labor and Delivery / 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 skills

#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, Central Richmond, Henrico, Hanover, Colonial Heights, VA, Medicaid