Integrated Nurse Case Manager/Registered Nurse/RN for Chronic/Complex Condition in Hampton, Newport News, Yorktown, Williamsburg, VA

Sentara Health Plans is hiring an Integrated Nurse Case Manager/Registered Nurse for Chronic/Complex Condition in Hampton, Newport News, Yorktown, Williamsburg, VA, and the surrounding areas. This is a full-time, work-from-home position that requires travel to conduct face-to-face home visits (target of at least 12 monthly).

About the Role

This permanent, full-time position (40 hours) supports members with chronic or complex conditions such as asthma, diabetes, heart failure, cancer, heart disease, and COPD. Standard working hours are 8am to 5pm EST, Monday through Friday. Applicants must reside in Hampton, Newport News, Yorktown, Williamsburg, VA, or the surrounding areas.

Responsibilities

• Provide case management services within the scope of licensure, developing, monitoring, evaluating, and revising member care plans to optimize health across the care continuum.
• Perform telephonic or face-to-face clinical assessments to identify, evaluate, coordinate, and manage member needs, including physical and behavioral health, social services, and long-term services.
• Identify members at high risk for complications and coordinate care with the member and healthcare team.
• Manage chronic illnesses, co-morbidities, and disabilities, ensuring cost-effective and efficient utilization of health benefits; conduct gap-in-care management for quality programs.
• Assist with implementing member care plans by facilitating authorizations/referrals within benefits structure or extra-contractual arrangements, as permissible.
• Interface with Medical Directors, Physician Advisors, and Interdisciplinary Teams on care management treatment plans.
• Present cases at case conferences for multidisciplinary focus and ensure compliance with regulatory, accrediting, and company policies.
• May assist in problem-solving with providers, claims, or service issues.

Target Member Population

• High Emergency Room (ER) utilizers
• Recent hospital discharges
• Members diagnosed with chronic/complex conditions (asthma, diabetes, heart failure, cancer, heart disease, COPD)

Requirements

• Associate or Bachelor’s Degree in Nursing REQUIRED
• Registered Nurse (RN) License (Compact or Virginia) REQUIRED
• 3 years of nursing experience REQUIRED
• Case Management experience highly preferred
• Managed Care or Health Plan experience preferred
• Experience working with chronic/complex condition members (asthma, diabetes, heart failure, cancer, heart disease, COPD) preferred
• Experience in home health, inpatient case management, hospice, transition of care, and discharge planning preferred
• Strong knowledge of physical, psychological, socio-cultural, and cognitive patient needs
• Excellent communication, problem-solving, and analytical skills

Benefits

• Medical, Dental, and 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
• Opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria are met

Sentara Health is an equal opportunity employer and maintains a tobacco-free environment. Remote work is available for associates in select states.