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Sentara Health

Nonprofit integrated health system and insurer

Integrated Case Manager-RN

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours
Full-timeDanville, VA, USA

About the Job

Requirements

  • An associate degree is required; a bachelor's degree is preferred.
  • Registered Nurse certification is required.
  • Three years of nursing experience are required.
  • Managed care experience is preferred.
  • Discharge planning experience is preferred.
  • Strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills are required.
  • Candidates must be able to travel to Danville, South Boston, Ringgold, Dry Fork, and Chatham for in-person face-to-face assessments.

Responsibilities

  • Provide case management services within the scope of licensure.
  • Develop, monitor, evaluate, and revise members' care plans to meet their needs and optimize health care across the care continuum.
  • Perform telephonic clinical assessments to identify, evaluate, coordinate, and manage members' physical and behavioral health, social service, and long-term service needs.
  • Identify members at risk of high-risk complications and coordinate care with members and the health care team.
  • Manage chronic illnesses, comorbidities, and disabilities while ensuring cost-effective and efficient utilization of health benefits.
  • Conduct gap-in-care management for quality programs.
  • Facilitate authorizations and referrals within the benefits structure or through extra-contractual arrangements, as permissible, to assist with implementation of member care plans.
  • Interface with Medical Directors, Physician Advisors, and interdisciplinary teams regarding care management treatment plans.
  • Present cases at case conferences for multidisciplinary review.
  • Ensure compliance with regulatory, accrediting, and company policies and procedures.
  • Assist with resolving provider, claims, or service issues as needed.
  • Address patients' individualized physical, psychological, sociocultural, spiritual, cognitive, and functional needs, including the need for diversified use of practices.

Desired Qualifications

  • Managed care experience is preferred.
  • Discharge planning experience is preferred.

About the Company

Sentara Health

Nonprofit integrated health system and insurer

Sentara Health operates a nonprofit, integrated health system across Virginia and North Carolina, running hospitals, urgent care, imaging, and primary care alongside its own health insurance plans. Services span virtual care, cancer and heart care, orthopedics, maternity, and home-based primary care for high-need patients. What sets Sentara apart is pairing hospital and physician care with its own health plans, coordinating coverage and treatment under one system. The goal is to improve health every day so people can keep doing what they love.

Company size
10,001+
Company stage
Not listed
Total funding
Not listed
Headquarters
Norfolk, VA
Founded
Not listed

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