Remote

NURSE CASE MGR

Sentara
life insurance, vision insurance, parental leave, paid time off, sick time, 401(k), 403(b)
United States, Virginia, Roanoke
Dec 21, 2024
City/State Wise, VA Overview Work Shift First (Days) (United States of America) Sentara Health is seeking a dedicated Nurse Case Manager for the SouthWest, VA region! This full-time, work-from-home position requires travel to conduct face-to-face home visits in the member's home or other locations within the SouthWest,VA region. Travel coverage includes Pounding Mill, Saltville, Chilhowie, Honaker, Lebanon, Rosedale, Meadowview, Castlewood, etc, with some coverage in Blue Ridge and Orange County. As an RN Clinician, you will provide case management services within the scope of your licensure, focusing on developing, monitoring, evaluating, and revising care plans to meet the individual needs of our members. The primary goal is to optimize healthcare outcomes across the care continuum. You will perform telephonic and in-person clinical assessments, identify members with high-risk complications, coordinate care with healthcare teams, and ensure the efficient use of healthcare resources. Key Responsibilities: Develop and implement individualized care plans for members to address their physical, behavioral, social, and long-term care needs. Perform telephonic and face-to-face clinical assessments to identify, evaluate, and manage members' needs. Coordinate care for high-risk members, including those with chronic conditions, co-morbidities, or disabilities. Manage care to ensure cost-effective and efficient utilization of health benefits, including conducting gap-in-care management for quality programs. Facilitate authorizations, referrals, and care plan implementation within benefits and coverage structures. Work closely with Medical Directors, Physician Advisors, and Interdisciplinary Teams to present and discuss case management treatment plans. Ensure compliance with regulatory, accrediting, and company policies and procedures. Assist with problem-solving related to provider, claims, or service issues as needed. Required Qualification: Registered Nurse License (RN) - Nursing License - Compact/Multi-State License required BSN (Bachelor of Science in Nursing) preferred Nursing experience, with a focus on case management, care coordination, or patient advocacy. Experience in PDN(private Duty Nursing): Proven experience providing skilled nursing care to patients in private home settings, with a strong understanding of patient care plans, coordination, and individualized treatment. Vent Dependent Patient care : Experience managing and caring for patients who are ventilator-dependent, including monitoring respiratory status, managing ventilation equipment, and coordinating with interdisciplinary teams to provide optimal care. 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. Ability to work independently and collaboratively in a remote, fast-paced environment. About Sentara Health: For over a decade, Modern Healthcare magazine has ranked Sentara Health among the nation's top integrated healthcare systems. With more than 300 sites of care in Virginia and northeastern North Carolina-including 12 acute care hospitals-we are committed to growth, innovation, and patient safety. Sentara Benefits: Sentara Health offers employees comprehensive health & welfare and retirement benefits (401(k)/403(b) with employer match) designed with you and your family's well-beingin mind. You have a variety of options for medical, dental and vision insurance, life insurance, disability, educational assistance, student loan repayment and voluntary benefits as well as Paid Time Off in the form of sick time, vacation time and paid parental leave Keyword: Indeed, Talroo, LinkedIn Job Summary RN Clinician 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. Requires an RN; BSN preferred Demonstrates the minimum knowledge, skills and abilities to care for the individualized needs of the patient to include physical, psychological, socio-cultural, spiritual and cognitive needs as well as functional abilities including the need for diversified use of such practices. Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills Qualifications: ALD - Associate's Level Degree: Nursing, BLD - Bachelor's Level Degree, BLD - Bachelor's Level Degree: Nursing Registered Nurse (RN) Single State - Nursing License - North Carolina, Registered Nurse (RN) Single State - Nursing License - Virginia Department of Health Professionals (VADHP), Registered Nurse License (RN) - Nursing License - Compact/Multi-State License Discharge Planning, Managed Care, Nursing Skills Communication, Complex Problem Solving, Critical Thinking, Judgment and Decision Making, Microsoft Office, Service Orientation Sentara Healthcare prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves. Per Clinical Laboratory Improvement Amendments (CLIA), some clinical environments require proof of education; these regulations are posted at ecfr.gov for further information. In an effort to expedite this verification requirement, we encourage you to upload your diploma or transcript at time of application. In support of our mission "to improve health every day," this is a tobacco-free environment.