Nurse Case Manager

Sentara is focused on living its mission — to improve health every day. In addition to providing world-class care, Sentara partners with organizations to provide significant support to address social determinants of health and advance the overall quality of life.

Sentara Health Plans is currently hiring an Integrated Nurse Case Manager in Tidewater Virginia Status: Full Time (40 hrs/wk) Shift: Day (8am-5pm) Location: Remote* in Tidewater, VA (Requires Travel) *Position is remote but does require in person face-to-face assessments multiple times throughout the week. Candidates must be able to travel frequently throughout the week to complete in person assessments. Location of assessments include: Virginia Beach, Chesapeake, Norfolk, Suffolk, Portsmouth. May occasionally include Hampton, Newport News, Williamsburg

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 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