Integrated Nurse Case Manager​/RN​/Maternity​/OBGYN

City/State
Lexington, VA

Work Shift
First (Days)

Overview:

Sentara Health Plansis hiring an Integrated Nurse Case Manager/RN/Maternity/OBGYN for Lexington, Buena Vista, Millboro, Goshen, Warm Springs, McDowell and surrounding areas!

This is a full-time, work-from-home position that requires travel to conduct face-to-face home visits for
low and high risk pregnant population/
member's homes or other locations in Lexington, Buena Vista, Millboro, Goshen, Warm Springs, McDowell and surrounding areas!

Status:
Full-time,permanent position (40 hours)

Standard working hours: 8am to 5pm EST, M-F

Location:
Applicants must be reside
in Lexi
ngton, Buena Vista, Millboro, Goshen, Warm Springs, McDowell and 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.

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 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

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 and use the following as your Keyword Search:
JR-89064

Talroo - Nursing

Care Coordination, Case Management, RN, Case Manager, Registered Nurse, BSN, ADN, Nursing, Managed Care, MCO, Health Plan, high-risk pregnant members, Maternity, OBGYN, Labor and Delivery, Mother and Baby, Postpartum, L&D, Lexington, Buena Vista, Millboro, Goshen, Warm Springs, Mc Dowell

Benefits:
Caring For Your Family and Your Career

• Medical, Dental, Vision plans

• Adoption, Fertility and Surrogacy Reimbursement up…