Integrated Case Manager

Overview

Sentara Health in Harrisonburg, VA is looking to hire an Integrated Case Manager, RN. This position will work with members under Sentara Health Plans who are both medically and behaviorally complex. This position requires both in-person/face-to-face assessments and remote telephonic assessments for members with Serious Mental Illnesses, Serious Emotional Disturbances (ages 2+) and Substance Abuse Disorders.

Applicants must be in the Harrisonburg, VA area. Travel may include up to 90 minutes one way.

About the role

The Integrated Case Manager is 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.

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.

Responsibilities

• Perform telephonic or face-to-face clinical assessments for members with Serious Mental Illnesses, Serious Emotional Disturbances (ages 2+) and Substance Abuse Disorders
• Develop, monitor, evaluate, and revise care plans to meet member needs and optimize health care across the care continuum
• Identify high-risk members and coordinate care with the member and health care team
• Manage chronic illnesses, co-morbidities, and/or disabilities to ensure cost-effective and efficient utilization of health benefits
• Conduct gap-in-care management for quality programs
• Assist with implementation of care plans by facilitating authorizations/referrals within benefits structure or extra-contractual arrangements
• Interface with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on care management treatment plans
• Present cases at case conferences for multidisciplinary focus
• Ensure compliance with regulatory, accrediting and company policies and procedures
• Assist in problem solving with provider, claims or service issues

Requirements

• Associates degree (required)
• Bachelors degree (preferred)
• Registered Nurse license (required)
• 3 years of nursing experience (required)

Preferred Qualifications

• Managed care experience
• Discharge planning experience

Work Schedule

First (Days)

Benefits

• 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
• Pet Insurance
• Legal Resources Plan
• Opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met