Integrated Nurse Case Manager/Registered Nurse/RN for Chronic/Complex Condition
Sentara Health
Summary
Sentara Health Plans is hiring an Integrated Nurse Case Manager/Registered Nurse/RN for Chronic/Complex Condition in Fredericksburg, Spotsylvania, VA, and the surrounding areas. This is a full-time, work-from-home position that requires travel to conduct face-to-face home visits (approx 2-3 times a week) for chronic/complex condition members (asthma, diabetes, heart failure, cancer, heart disease, COPD).
Job description
Primary Responsibilities
- 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
Target Member Population
- High Emergency Room (ER) utilizers
- Recent hospital discharges
- Members diagnosed with chronic/complex conditions (Asthma, diabetes, heart failure, cancer, heart disease, COPD)
Requirements
- Associate or Bachelors Degree in Nursing REQUIRED
- Registered Nurse (RN) License (Compact or Virginia) REQUIRED
- 3 years experience in Nursing REQUIRED
- Case Management experience highly preferred
- Managed Care or Health Plan experience preferred
- Experience working with chronic/complex condition members (Asthma, diabetes, heart failure, cancer, heart disease, COPD) preferred
- Experience in home health experience, inpatient case management, hospice, transition of care, and discharge planning preferred
- Strong knowledge of physical, psychological, socio-cultural, and cognitive patient needs
- Excellent communication skills, both oral and written, as well as strong problem-solving and analytical
Benefits
- Medical, Dental & Vision
- Adoption, Fertility & Surrogacy Reimbursement
- Paid Time Off
- Sick Leave
- Paid Parental & Family Caregiver Leave
- Emergency Backup Care
- Long-Term Disability Insurance
- Short-Term Disability Insurance
- Critical Illness Plans
- Life Insurance
- 401(k)/403(b) with Employer Match
- Tuition Assistance
- Student Debt Pay Down
- Pet Insurance
- Legal Resources Plan
- Annual Discretionary Bonus
Company overview
Sentara Health is a leading not-for-profit integrated healthcare delivery system serving Virginia, northeastern North Carolina, and Florida. Founded in 1888 and headquartered in Hampton Roads, Virginia, Sentara operates 12 acute care hospitals across its service area, with 10 hospitals holding prestigious Magnet® recognition for nursing excellence. The organization employs approximately 34,000 healthcare professionals and serves over 1 million health plan members through its Sentara Health Plans division. As one of the top 20 largest not-for-profit integrated health systems in the United States, Sentara is nationally recognized for clinical quality, safety, and innovation. The system has received numerous accolades including Health Quality Innovator of the Year (2024), Forbes' "America's Best-In-State Employer" (2024), and inclusion in IBM Watson Health's "Top 15 Health Systems." Sentara's comprehensive services span hospital care, outpatient facilities, home health, hospice services, and specialized programs like the Nightingale air ambulance service, which has completed over 20,000 missions since 1982.