Integrated Case Manager- Registered Nurse

Overview

Sentara Health in Woodbridge, VA is seeking an Integrated Case Manager, RN. This is a remote position requiring residency in Woodbridge and surrounding areas due to travel requirements. The role involves case management services, clinical assessments, care plan development, and coordination with healthcare teams.

Responsibilities

• Develops, monitors, and evaluates member care plans to optimize health care across the care continuum.
• Identifies and manages high-risk complications, coordinating care with the member and healthcare team.
• Manages chronic illnesses, co-morbidities, and disabilities, ensuring cost-effective and efficient utilization of health benefits.
• Conducts gap analysis for quality programs and assists in implementing member care plans.
• Facilitates authorizations and referrals within the benefits structure or extra-contractual arrangements.
• Interacts with Medical Directors, Physician Advisors, and 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.
• Assists in problem-solving with provider, claims, or service issues.

Requirements

• Registered Nurse certification required.
• 3 years of nursing experience required.
• Managed care experience preferred.
• Discharge planning experience preferred.

Qualifications

• Associates or Bachelor’s degree in Nursing preferred.
• Demonstrated knowledge, skills, and abilities to care for the individualized needs of patients, including physical, psychological, socio-cultural, spiritual, and cognitive needs, as well as functional abilities.
• Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

Skills

• Effective communication and collaboration skills.
• Ability to manage multiple tasks and prioritize responsibilities.
• Knowledge of managed care systems and discharge planning processes.

Benefits

• Career Advancement: Annual discretionary bonus based on established system and employee eligibility criteria.
• Health Benefits: Medical, Dental, Vision plans; Adoption, Fertility, and Surrogacy Reimbursement; Emergency Backup Care; Long-Term, Short-Term Disability, and Critical Illness plans; Life Insurance; 401(k)/403(b) with Employer Match; Tuition Assistance; Discounted Educational Opportunities through Guild Education; Student Debt Pay Down; Reimbursement for Certifications; Free Access to Complete CEUs and Professional Development.
• Work-Life Balance: Paid Time Off and Sick Leave; Paid Parental & Family Caregiver Leave; Pet Insurance; Legal Resources Plan.