This is a Full Time position with day shift hours and great benefits!
Requires travel to conduct face-to-face home visits in the member’s home or other locations within the Central Region -Fredericksburg, Stafford, Spotsylvania, Caroline County, King George, Westmoreland, King William, Hanover, Goochland, Henrico, Richmond City, etc . The members will be predominantly in the above areas and possibly in Charlottesville Region (Locust Grove/Orange County, Louisa) & Northern VA Region (Prince William, Culpeper, Fauquier, Rappahannock)
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
Preferred: Private duty nursing experience and knowledgeable with ventilators in a facility or home
EducationAssociates or Bachelors Degree in Nursing
Certification/LicensureRegistered Nurse License (RN) - Nursing License - Compact/Multi-State License required.Experience3 years experience in Nursing
Discharge planning experience preferred
Managed Care experience preferred
Preferred: Private duty nursing and knowledgeable with ventilators in a facility or home
Keywords: Care Coordination, Case Management, Human Services, Community Health, Health Education, RN Case Manager, Registered Nurse, BSN, ADN, Private Duty, Ventilator, LinkedIn, Talroo-Nursing
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.