Sign-on bonus offer to qualified applicants!

The position requires both in-person face-to-face assessments and remote telephonic assessments for the waiver population.

Status: Full-timepermanent position (40 hours)

Standard working hours: 8am to 5pm EST M-F

Location: Applicants must reside in Hampton and Newport News VA and surrounding areas!

Primary responsibilities include:

• Responsible for case management services within the scope of licensure; develops monitors evaluates and revises the members care plan to meet the members 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 members 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.

Required qualifications:

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

• Associate or Bachelors Degree in Nursing REQUIRED

• 3 years experience in Nursing REQUIRED

Preferred qualifications:

• Case Management experience preferred

• Discharge planning experience preferred

• Managed Care or Health Plan experience preferred

Education:

• Bachelors Degree in Nursing preferred

Certification/Licensure

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

Preferred qualifications:

• 3 years experience in Nursing REQUIRED

• Case Management experience preferred

• Discharge planning experience preferred

• Managed Care or Health Plan experience preferred

Sentara Health Plans provides health plan coverage to close to 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 provider network including specialists primary care physicians and hospitals.

We offer programs to support members with chronic illnesses customized wellness programs and integrated clinical and behavioral health servicesall to help our members improve their health.

Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.

Be a part of an excellent healthcare organization that cares about our People Quality Patient Safety Service and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

To apply please go to and use the following as your Keyword Search: JR-81890

Talroo - Nursing

Care Coordination Case Management RN Case Manager Registered Nurse BSN ADN Nursing Hampton Newport News Peninsula Virginia VA Managed Care MCO Health Plan