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Award-winning: Sentara is a Virginia and Northeastern North Carolina based not-for-profit integrated healthcare provider that has been in business for over 131 years. Offering more than 500 sites of care including 12 hospitals, PACE (Elder Care), home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan. The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy!
Sentara Health Plan is hiring a Full-Time Day-shift
RN Case Manager for the Commercial Complex Cases Integrated Care Management team
This is a remote, telephonic position however, candidates must reside in Virginia or North Carolina.
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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
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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
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Interfaces with Medical Directors, Physician Advisors, and/or Inter-Disciplinary Teams on care management treatment plans
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Presents cases at case conferences for multidisciplinary focus. Ensures compliance with regulatory, accrediting, and company policies and procedures
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May assist in problem-solving with provider, claims, or service issues.
Sentara Health Plans is the health insurance division of Sentara Health.
Sentara Health Plans provides health insurance coverage through a full suite of commercial products
Education
- RN diploma required
- BSN preferred
Certification/Licensure
- Valid RN license
Experience
- 3 years of Case Management RN experience required, Complex Case Integrated Commercial Managed Care and discharge planning preferred.
- Experience with JIVA and Epic experience preferred.
- Proficient with NCQA guidelines
keywords: LinkedIn, Case Management, RN, Registered Nurse, BSN, Talroo-Nursing, Monster, care coordinator, ACM, CCM, TCM, CMAC or CGMT-BC, MCG, Comercial health plan payors, Managed Care, JIVA, Epic, QNXT, NCQA, member engagement, discharge planning, oncology, ESRD, transplant, Autoimmune, Behavioral health, integrated care, complex cases
Sentara 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.
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