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-F
Location: 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 REQUIRED
Preferred 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 preferred
Sentara 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
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Talroo - Nursing
Care 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