Integrated Nurse Case Manager, Registered Nurse (RN)
Sentara Health
Integrated Nurse Case Manager, RN – Maternity/OBGYN
Sentara Health
full-time
Posted on:
Origin: • 🇺🇸 United States • Virginia
Visit company websiteJob Level
Mid-LevelSenior
About the role
- 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.
Requirements
- Associate or Bachelors Degree in Nursing REQUIRED
- Registered Nurse (RN) License (Compact or Virginia) REQUIRED
- 3 years experience in Nursing REQUIRED
- Case Management experience preferred
- Managed Care or Health Plan experience preferred
- Experience working with low and high risk pregnant population/ Maternity/OB/L&D/Mother Baby/Postpartum experience preferred
- Strong knowledge of physical, psychological, socio-cultural, and cognitive patient needs.
- Excellent communication skills, both oral and written, as well as strong problem-solving and analytical skills.
