Integrated Nurse Case Manager/Registered Nurse (RN) for Maternal Health/ Perinatal in Central Richmond (Henrico, Hanover, Colonial Heights, VA)

Overview

Sentara Health Plans is hiring an Integrated Nurse Case Manager/RN for Maternal Health/Perinatal for Central Richmond (Henrico, Hanover, Colonial Heights, VA and the surrounding areas).

Primary responsibilities

• 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
• Affords assistance 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

Education

Associate or Bachelors Degree in Nursing REQUIRED

Certification/Licensure

Registered Nurse (RN) License (Compact or Virginia) REQUIRED

Experience

• 3 years experience in Nursing REQUIRED
• Case Management experience preferred
• Managed Care or Health Plan or Medicaid experience preferred
• Experience working with low and high risk pregnant population (Maternal Health / Perinatal / OB-GYN /Labor and Delivery / Mother-Baby / Postpartum) experience preferred

Skills

• 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

Benefits

• Caring For Your Family and Your Career 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 Reimbursement for certifications and free access to complete CEUs and professional development
• Pet Insurance
• Legal Resources Plan