This is a full-time, work-from-home position that requires travel to conduct face-to-face home visits for chronic/complex condition members (asthma, diabetes, heart failure, cancer, heart disease, COPD) Virginia Beach, Norfolk, VA and the surrounding areas!
Status: Full-time, permanent position (40 hours)
Standard working hours: 8am to 5pm EST, M-F
Location: Applicants must reside in Virginia Beach, Norfolk, VA and the surrounding areas!
Primary responsibilities include:
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.
Target Member Population Includes:
High Emergency Room (ER) utilizers
Recent hospital discharges
Members diagnosed with heart failure, COPD, asthma or diabetes
Education:
Associate or Bachelors Degree in Nursing REQUIRED
Certification/Licensure:
Registered Nurse (RN) License (Compact or Virginia) REQUIRED
Experience:
3 years experience in Nursing REQUIRED
Case Management experience preferred
Managed Care or Health Plan experience preferred
Experience working with chronic/complex condition members (Asthma, diabetes, heart failure, cancer, heart disease, COPD), home health experience, inpatient case management experience, hospice 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
Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.
Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.
We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health.
Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.
Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!
To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-94794
Talroo – Health Plan
Managed Care, MCO, Health Plan, Healthcare, Health Insurance, Nursing, RN, Registered Nurse, Medicaid, Chronic, Complex condition members, Asthma, diabetes, heart failure, cancer, heart disease, COPD, home health experience, inpatient case management, hospice, emergency room, ED, Virginia Beach, Norfolk, VA, Remote, Virginia