Integrated Case Manager/Registered Nurse (RN) for the Commercial Complex Cases - Remote in Virginia or North Carolina

City/State Norfolk, VA Work Shift First (Days) Overview: Sentara Health Plan is hiring an Integrated Case Manager/Registered Nurse (RN) for the Commercial Complex Cases- Remote in Virginia or North Carolina! Status: Full-time, permanent position (40 hours) Standard work hours: 8am to 5pm EST, M-F Location: This is a remote, telephonic position and candidates must reside in Virginia or North Carolina. Overview: • 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 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 arrangement 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. Education • BLD - Bachelor's Level Degree preferred Certification/Licensure: • Registered Nurse (RN) License (Compact or Virginia) REQUIRED Experience • 3 years of Case Management RN experience REQUIRED • Complex Case Integrated Commercial Managed Care and discharge planning preferred. • Experience in the ICU/ED, Behavioral Health, and Oncology are helpful. • Experience with JIVA and Epic experience preferred. • Proficient with NCQA guidelines Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees. Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals. 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! To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-94917 Keywords: Case Management, RN, Registered Nurse, BSN, Talroo-Nursing, Monster, care coordinator, ACM, CCM, TCM, CMAC or CGMT-BC, MCG, Commercial health plan payors, Managed Care, JIVA, Epic, QNXT, NCQA, member engagement, discharge planning, ESRD, transplant, Autoimmune, Behavioral health, integrated care, complex cases, substance abuse, behavioral health, ICU, Emergency Department, ED, Oncology, End-Stage Renal Disease, Suicidal Ideation, remote, Virginia, VA, North Carolina, NC, Health insurance, Health Care, MCO, Managed Care Benefits: Caring For Your Family and Your Career • Medical, Dental, Vision plans • Adoption, Fertility and Surrogacy Reimbursement up to $10,000 • Paid Time Off and Sick Leave • Paid Parental & Family Caregiver Leave • Emergency Backup Care • Long-Term, Short-Term Disability, and Critical Illness plans • Life Insurance • 401k/403B with Employer Match • Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education • Student Debt Pay Down – $10,000 • Reimbursement for certifications and free access to complete CEUs and professional development •Pet Insurance •Legal Resources Plan •Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met. Sentara Health is an equal opportunity employer and 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. In support of our mission “to improve health every day,” this is a tobacco-free environment. For positions that are available as remote work, Sentara Health employs associates in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. Apply tot his job Apply To this Job