Integrated Nurse Case Manager/RN/NICU- Tidewater region! - Virginia Beach Virginia

Company: Sentara
Location: Virginia Beach, Virginia
Posted On: 01/25/2025

City/StateNewport News, VAOverviewWork ShiftFirst (Days) (United States of America)Sentara Health Plansis hiring an Integrated Nurse Case Manager/RN/NICUfor the Tidewater region!Sign-on bonus offered to qualified applicants!The position requires both in-person face-to-face assessments and remote telephonic assessments for vulnerable infant members, including those diagnosed with neo-natal abstinence syndrome, classified substance-exposed, or admitted at NICU Level 3.Status: Full-time,permanent position (40 hours)Standard working hours: 8am to 5pm EST, M-FLocation: Applicants must reside in the Tidewater region: Norfolk, VA Beach, Suffolk, Chesapeake, Portsmouth, Williamsburg and Newport News, VA.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 in Virginia/Multi-state/Compact REQUIRED
  • Associate or Bachelors Degree in Nursing REQUIRED
  • 3 years experience in Nursing REQUIREDPreferred qualifications:
    • BSN preferred
    • Case Management experience preferred
    • Discharge planning experience preferred
    • Managed Care or Health Plan experience preferred
    • Experience in Labor and Delivery, NICU is highly preferredSentara Health Plans is the health insurance division of Sentara Healthcare.Sentara Health Plans provides health insurance coverage through a full suite of commercial products including consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees.With more than 30 years' experience in the insurance business and 20 years' experience serving Medicaid populations, 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.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.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-72197#IndeedTalroo - NursingCare Coordination, Case Management, RN, Case Manager, Registered Nurse, BSN, ADN, Nursing, Managed Care, MCO, Health Plan, Neo-Natal abstinence syndrome, substance-exposed, NICU, Norfolk, VA Beach, Suffolk, Chesapeake, Portsmouth, Williamsburg and Newport News, Virginia, Tidewater Job SummaryRN 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.
      
      Requires an RN; BSN preferred
      Demonstrates the minimum knowledge, skills and abilities to care for the individualized needs of the patient to include physical, psychological, socio-cultural, spiritual and cognitive needs as well as functional abilities including the need for diversified use of such practices. Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skillsQualifications:ALD - Associate's Level Degree: Nursing, BLD - Bachelor's Level Degree, BLD - Bachelor's Level Degree: NursingRegistered Nurse (RN) Single State - Nursing License - North Carolina, Registered Nurse (RN) Single State - Nursing License - Virginia Department of Health Professionals (VADHP), Registered Nurse License (RN) - Nursing License - Compact/Multi-State LicenseDischarge Planning, Managed Care, NursingSkillsCommunication, Complex Problem Solving, Critical Thinking, Judgment and Decision Making, Microsoft Office, Service OrientationSentara Healthcare prides itself 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 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. More...

          

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