Job Description - Remote (Northern Virginia Only) Nurse Case Manager

• Location : Remote / Work From Home
• Salary : $43 - $83 / HOUR
• Job Type : FULL_TIME

Optima Northern Virginia is hiring a Nurse Case Manager

This position is Remote for candidates that live in Northern Virginia: Winchester, Fairfax, Culpper, Manassas, Arlington, Luray, Front Royal, Leesburg and surrounding areas!

Sign on Bonus for Qualified Applicants

The Nurse Case Manager is 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.

Nurse Case Managers manage 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. Nurse Case Manager 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. 

Job Requirements:

• RN License (Virginia/Compact)
• Associates or Bachelor’s Degree in Nursing
• Nursing experience 3 years required
• Discharge planning experience preferred
• Managed Care experience preferred

Benefits: Sentara offers an attractive array of full-time benefits to include Medical, Dental, Vision, Paid Time Off, Sick, Tuition Reimbursement, a 401k/403B, 401a, Performance Plus Bonus, Career Advancement Opportunities, Work Perks and more.

Sentara employees strive to make our communities healthier places to live. We’re setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For more information about our employee benefits, https://www.sentaracareers.com/explore-sentara/benefits/ 

Join our team, where we are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, growth! 

The Nurse Case Manager is 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. RN Case Manager 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. Nurse Case Manager may assist in problem solving with provider, claims or service issues.

License/Certification

• Registered Nurse License (RN) – North Carolina
• Registered Nurse License (RN) – New Mexico – New Mexico
• Registered Nurse License (RN) – New Jersey – New Jersey
• Registered Nurse License (RN) – New Hampshire – New Hampshire
• Registered Nurse License (RN) – Nebraska – Nebraska
• Registered Nurse License (RN) – Montana – Montana
• Registered Nurse License (RN) – Missouri – Missouri
• Registered Nurse License (RN) – Mississippi – Mississippi
• Registered Nurse License (RN) – Maryland – Maryland
• Registered Nurse License (RN) – Maine – Maine
• Registered Nurse License (RN) – Louisiana – Louisiana
• Registered Nurse License (RN) – Kentucky – Kentucky
• Registered Nurse License (RN) – Kansas – Kansas
• Registered Nurse License (RN) – Iowa – Iowa
• Registered Nurse License (RN) – Indiana – Indiana
• Registered Nurse License (RN) – Idaho – Idaho
• Registered Nurse License (RN) – Georgia – Georgia
• Registered Nurse License (RN) – Florida – Florida
• Registered Nurse License (RN) – Delaware – Delaware
• Registered Nurse License (RN) – Colorado – Colorado
• Registered Nurse License (RN) – Arkansas – Arkansas
• Registered Nurse License (RN) – Arizona – Arizona
• Registered Nurse License (RN) – Alabama – Alabama
• Registered Nurse License (RN) – Other/National
• Registered Nurse License (RN) – Wyoming – Wyoming
• Registered Nurse License (RN) – Wisconsin – Wisconsin
• Registered Nurse License (RN) – West Virginia – West Virginia
• Registered Nurse License (RN) – Virginia
• Registered Nurse License (RN) – Utah – Utah
• Registered Nurse License (RN) – Texas – Texas
• Registered Nurse License (RN) – Tennessee – Tennessee
• Registered Nurse License (RN) – South Dakota – South Dakota
• Registered Nurse License (RN) – South Carolina – South Carolina
• Registered Nurse License (RN) – Oklahoma – Oklahoma
• Registered Nurse License (RN) – North Dakota – North Dakota

Education

• Bachelor’s Level Degree
• Bachelor’s Level Degree
• Associate’s Level Degree

Experience

• Managed Care 2 years
• Discharge Planning Previous Experience
• Nursing 3 years

Skills

• Judgment and Decision Making
• Critical Thinking
• Complex Problem Solving
• Communication
• Service Orientation
• Microsoft Office

Sentara 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.