Virginia Premier, a division of Sentara Health Plan is currently seeking a full-time, Integrated Nurse Case Manager

in the Staunton, Waynesboro, Harrisonburg, VA area.

This position is remote and requires face to face and telephonic assessments.

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.

Minimum Qualifications:

• RN License (Virginia/Compact State) required
• Nursing 3 years’ experience required
• Associate’s or Bachelor’s level degree preferred
• Previous Health Plan experience preferred
• Previous Case Management experience preferred

Skills:

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

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

Along with competitive salary we also offer the following benefits:

Adoption, Infertility, and Surrogacy Reimbursement

Educational Assistance Programs, including Tuition Assistance

Emergency Back-Up Care

Financial Wellness Tools, including extra student debt payments on your student loans.

Medical, Dental, and Vision Benefits

Paid Annual Leave (PAL)

Paid Parental Leave

Sentara Health Plan is the health insurance division of Sentara Healthcare doing business as Optima Health and Virginia Premier.

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.

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!

keywords: nursing, discharge planning, managed care, case management, #indeed

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. 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 skills

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• Bachelor's Level Degree
• Associate's Level Degree
• Bachelor's Level Degree

• Managed Care 2 years
• Discharge Planning Previous Experience
• Nursing 3 years

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