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Sentara Health

Nonprofit integrated health system and insurer

Integrated Nurse Case Manager

Medical, Clinical & VeterinaryPosted on Nov 13
Full-timeManassas, VA, USA

About the Job

Requirements

  • An associate's or bachelor's degree in Nursing is required.
  • A Registered Nurse license with a compact or multi-state license is required.
  • Three years of nursing experience is required.

Responsibilities

  • Provide case management services within the scope of licensure; develop, monitor, evaluate, and revise member care plans to meet needs and optimize healthcare across the care continuum.
  • Perform telephonic or face-to-face 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 complications and coordinate care with the member and healthcare team.
  • Manage chronic illnesses, comorbidities, and disabilities to ensure cost-effective and efficient use 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 help implement member care plans.
  • Interface with Medical Directors, Physician Advisors, and interdisciplinary teams on care management treatment plans.
  • Present cases at case conferences for multidisciplinary review and ensure compliance with regulatory, accrediting, and company policies and procedures.
  • Assist with resolving provider, claims, or service issues as needed.
  • Travel to conduct face-to-face home visits in members' homes or other locations throughout Northern Virginia.

Desired Qualifications

  • Discharge planning experience is preferred.
  • Managed care experience is preferred.
  • Private duty nursing experience and knowledge of ventilators in a facility or home are 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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