The position requires both in-person face-to-face assessments and remote telephonic assessments for the waiver population.
Status: Full-time, permanent position (40 hours)
Standard working hours: 8am to 5pm EST, M-F
Location: Applicants must reside in Hampton and Newport News, VA and 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.
Required qualifications:
Registered Nurse (RN) License (Compact or Virginia) REQUIRED
Associate or Bachelors Degree in Nursing REQUIRED
3 years experience in Nursing REQUIRED
Preferred qualifications:
Case Management experience preferred
Discharge planning experience preferred
Managed Care or Health Plan experience preferred
Education:
Bachelors Degree in Nursing preferred
Certification/Licensure
Registered Nurse (RN) License (Compact or Virginia) REQUIRED
Preferred qualifications:
3 years experience in Nursing REQUIRED
Case Management experience preferred
Discharge planning experience preferred
Managed Care or Health Plan experience preferred
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-81890
Talroo - Nursing
Care Coordination, Case Management, RN, Case Manager, Registered Nurse, BSN, ADN, Nursing, Hampton, Newport News, Peninsula, Virginia, VA, Managed Care, MCO, Health Plan
We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for Full Time employment is:$66,830.40-$111,384.00. Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.