Integrated Nurse Case Manager/Registered Nurse/RN for Chronic/Complex Condition in Fredericksburg, Spotsylvania, VA

Sentara Health Plans is hiring an Integrated Nurse Case Manager/Registered Nurse for chronic and complex condition management in Fredericksburg, Spotsylvania, VA, and surrounding areas. This full-time, work-from-home position requires travel for face-to-face home visits approximately 2-3 times per week.

About the Role

This permanent, full-time position (40 hours) operates on standard working hours of 8am to 5pm EST, Monday through Friday. Applicants must reside in Fredericksburg, Spotsylvania, VA, or the surrounding areas.

Responsibilities

• Provide case management services within the scope of licensure; develop, monitor, evaluate, and revise member care plans to optimize healthcare across the 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 for high-risk complications and coordinate care with the member and healthcare 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 the implementation of member care plans by facilitating authorizations/referrals within benefits structure or extra-contractual arrangements, as permissible.
• 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.
• May assist in problem-solving with provider, 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 experience in Nursing REQUIRED

Qualifications

• 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 skills, both oral and written, as well as strong problem-solving and analytical skills

About Sentara Health Plans

Sentara Health Plans provides health plan coverage to nearly one million members in Virginia. We offer a full suite of commercial products, including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs, and plans serving Medicare and Medicaid enrollees. Our quality provider network features a robust selection of specialists, primary care physicians, and hospitals. We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all aimed at improving member health.

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 a tobacco-free environment. For remote work positions, Sentara employs associates in select states, including Virginia.