Remote (Northern Virginia Only) Nurse Case Manager

Full time
Posted Today
JR-34252

City/State

Woodbridge, VA

Overview

Work Shift

First (Days) (United States of America)

Optima Northern Virginia is hiring a Nurse Case Manager

This position is Remote for candidates that live in Northern Virginia: Winchester, Fairfax, Culpper, Manassas, Arlington, Luray, Front Royal, Leesburg and surrounding areas!

Sign on Bonus for Qualified Applicants

The Nurse Case Manager is 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.

Nurse Case Managers manage 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. Nurse Case Manager 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.

Job Requirements:

• RN License (Virginia/Compact)
• Associates or Bachelor’s Degree in Nursing
• Nursing experience 3 years required
• Discharge planning experience preferred
• Managed Care experience preferred

Benefits: Sentara offers an attractive array of full-time benefits to include Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B, 401a, Performance Plus Bonus, Career Advancement Opportunities, Work Perks and more.

Sentara employees strive to make our communities healthier places to live. We’re setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For more information about our employee benefits, https://www.sentaracareers.com/explore-sentara/benefits/

Join our team, where we are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, growth!

Keywords: nursing, discharge planning, managed care, case management, RN, nurse, health plan, health care, Indeed, Monster

Job Summary

The Nurse Case Manager is 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. RN Case Manager 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. Nurse Case Manager may assist in problem solving with provider, claims or service issues.

Qualifications:

ALD – Associate’s Level Degree: Nursing, BLD – Bachelor’s Level Degree, BLD – Bachelor’s Level Degree: Nursing