Integrated Case Manager​/Registered Nurse; RN; Alexandria​/Woodbridge

Integrated Case Manager/Registered Nurse (RN) (Alexandria/Woodbridge)

Full‑time, permanent position (40 hours). Standard working hours: 8am to 5pm EST, Monday–Friday. Primary duties include telephonic or face‑to‑face clinical assessments, case management across the care continuum, coordination of high‑risk complications, chronic illness management, authorization/referral facilitation, and multidisciplinary case conferences.

Location:

Applicants must reside in Alexandria/Woodbridge and the surrounding areas. The position is work‑from‑home with travel to conduct home visits for complex condition members (asthma, diabetes, heart failure, cancer, heart disease, COPD).

• 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.

• 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 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 skills.

• 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
• Annual discretionary bonus opportunity if eligibility criteria are met.

Sentara Health Plans provides coverage to close to one million members in Virginia, offering a full suite of commercial products and specialized services to support chronic illness and wellness. Practices a family‑friendly culture with community involvement and career development opportunities.

Sentara Health is an equal opportunity employer and values diversity, inclusion, and belonging.

For positions available as remote work, Sentara Health employs associates in many states including 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.

• Mid‑Senior level

• Full‑time

• Health Care Provider

• Hospitals and Health Care