Emergency Department, Inpatient Case Management- Registered Nurse

City/State: Hampton, VA

About the Role

The ICM, RN position supports the Emergency Department and is accountable to health plan clinical leadership for high‑risk member management, utilization reduction, care transition performance, and enterprise population health objectives. The role provides and facilitates comprehensive care management across the healthcare continuum, focusing on patient transition to the appropriate level of care while promoting clinical appropriateness and managing length of stay. Responsibilities include developing and implementing individualized care plans that address physical, mental, and psychosocial needs, collaborating with the healthcare team and patients/caregivers, monitoring utilization of services, and identifying members who can be safely supported through observation, outpatient follow‑up, home‑based services, community resources, or care management programs.

Responsibilities

• Support Emergency Department operations as part of an integrated care coordination model.
• Manage high‑risk health plan members and drive utilization reduction strategies.
• Facilitate care transitions and improve length‑of‑stay metrics.
• Provide comprehensive case management services for in‑patient patients needing coordinated care.
• Develop and implement individualized care plans addressing physical, mental, and psychosocial needs.
• Collaborate with ED providers, nursing, inpatient case management, ambulatory care, and health plan teams.
• Monitor and promote effective utilization of health services.
• Communicate with patients, caregivers, and the interdisciplinary team to manage care and transitions.
• Identify candidates for observation, outpatient follow‑up, home‑based services, community resources, or care management programs.

Requirements

• Education: RN Associate’s, Bachelor’s, Diploma, Master’s, or Doctorate degree.
• Licensure: Active RN license (compact/multi‑state or Virginia single state).
• Certifications: Basic Life Support (BLS) from the American Heart Association within 90 days of hire; Case Management certification (ACM, CCM, CCCTM, CMAC, or CMGT‑BC) required within one year of eligibility.
• Experience: Minimum 1 year nursing experience (required); 1 year acute care experience preferred; 1 year case management experience preferred; ED RN experience strongly preferred.