City/StateFairfax, VA
Work ShiftFirst (Days)
Overview:Sentara Health Plans is hiring an Integrated Care Manager/ Registered Nurse (RN) LTSS Waiver Members/Medicaid - Remote in NOVA (Fairfax, Springfield and Alexandria, VA) and the surrounding areas!Status: Full-time, permanent position (40 hours)Standard working hours: 8 am to 5 pm EST, M-FThe position requires in person/face-to-face assessments with remote/home office for the Long-Term Services and Supports (LTSS) Waiver Members/Medicaid in Northern Virginia (Fairfax, Springfield, and Alexandria, VA), and the surrounding areas! May travel up to 1 hour max.Location: Candidate must reside in Northern Virginia (Fairfax, Springfield, and Alexandria, VA), and the surrounding areasJob responsibilities:- 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.
Education:- BLD - Bachelor's Level Degree in Nursing preferred
Certification/Licensure:- Registered Nurse (RN) License (Compact or Virginia) REQUIRED
Experience:- 3 years experience in Nursing REQUIRED
- Managed Care/ Health Plan/ Health Insurance experience highly preferred
- Case Management experience preferred
- Long-Term Services and Supports (LTSS) waiver and Home Health experience preferred
- Behavioral Health experience is secondary
Benefits: Caring For Your Family and Your Career• 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.
To apply, please go to www.sentaracareers.com and use the following as your Keyword Search:JR-103241Talroo - Health Plan
Keywords: Medicaid, Managed Care, Health Plan, Health Insurance, MCO, Integrated Case Manager, Registered Nurse, RN, Nursing, Fairfax, Springfield, and Alexandria, VA, Northern Virginia, NOVA, Long-Term Services and Supports (LTSS), Waiver, Home Health
For positions that are available as remote work, Sentara Health employs associates in the following states:Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.
