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Sentara Health

Nonprofit integrated health system and insurer

Integrated Case Manager

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours
Full-timeFairfax, 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.
  • Strong oral, written, interpersonal communication, problem-solving, facilitation, and analytical skills are required.
  • The position requires the ability to provide individualized care that addresses physical, psychological, socio-cultural, spiritual, cognitive, and functional needs.

Responsibilities

  • Provide case management services within the scope of licensure.
  • Develop, monitor, evaluate, and revise member care plans to meet 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 complications and coordinate care with members and the health care team.
  • Manage chronic illnesses, comorbidities, and disabilities while ensuring 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 extra-contractual arrangements, as permissible, to support implementation of member care plans.
  • Interface with Medical Directors, Physician Advisors, and interdisciplinary teams on care management treatment plans.
  • Present cases at case conferences for a multidisciplinary focus.
  • Ensure compliance with regulatory, accrediting, and company policies and procedures.
  • Assist in resolving provider, claims, or service issues as needed.

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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