Remote Nurse Case Manager, VA

Sentara

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Full time
JR-42158

City/State

Norfolk, VA

 

 

Overview

 

Work Shift

First (Days) (United States of America)

 

 

Optima Health is hiring a Nurse Case Manager for the Health Care Services Department. – Remote in Virginia. 

 

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

 

RN Clinician 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.

 

 

Qualifications:

 

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

 

Discharge Planning, Managed Care, Nursing

 

 

 

 

Skills

 

Communication, Complex Problem Solving, Critical Thinking, Judgment and Decision Making, Microsoft Office, Service Orientation

 

 

Sentara Healthcare prides itselfa on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

 

Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application.

In support of our mission “to improve health every day,” this is a tobacco-free environment.