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Integrated Nurse Case Manager, Registered Nurse, Maternity/OBGYN
Sentara HealthIntegrated Nurse Case Manager/RN managing health care plans for low and high risk pregnant members. Collaborating with health care teams and ensuring quality care in Maternity/OBGYN.
About the role
Key responsibilities & impact- 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
What you’ll need- Bachelors Degree in Nursing preferred
- 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.
Benefits
Comp & perks- Medical, Dental, Vision plans
- Adoption, Fertility and Surrogacy Reimbursement up to $10,000
- Paid Time Off and Sick Leave
- Paid Parental & Family Caregiver Leave
- Emergency Backup Care
- Long-Term, Short-Term Disability, and Critical Illness plans
- Life Insurance
- 401k/403B with Employer Match
- Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
- Student Debt Pay Down – $10,000
- Reimbursement for certifications and free access to complete CEUs and professional development
- Pet Insurance
- Legal Resources Plan
- Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
case managementclinical assessmentscare plan developmentchronic illness managementgap in care managementauthorization facilitationcoordination of careevaluation of member needsbehavioral health managementsocial services coordination
Soft Skills
communication skillsproblem-solving skillsanalytical skillsinterpersonal skillsteam collaboration
Certifications
Registered Nurse (RN) License