City/State
Fairfax, VA
Work Shift
First (Days)
Status: Full-time, permanent position (40 hours)
Standard working hours: 8 am to 5 pm EST, M-F
The position requires in person/face-to-face assessments with remote/home office for the Long-Term Services and Supports (LTSS) Waiver Members/Medicaid in Northern Virginia (Fairfax, Springfield, and Alexandria, VA), and the surrounding areas! May travel up to 1 hour max.
Location: Candidate must reside in Northern Virginia (Fairfax, Springfield, and Alexandria, VA), and the surrounding areas
Job responsibilities:
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:
BLD - Bachelor's Level Degree in Nursing preferred
Certification/Licensure:
Registered Nurse (RN) License (Compact or Virginia) REQUIRED
Experience:
3 years experience in Nursing REQUIRED
Managed Care/ Health Plan/ Health Insurance experience highly preferred
Case Management experience preferred
Long-Term Services and Supports (LTSS) waiver and Home Health experience preferred
Behavioral Health experience is secondary
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-103241
Talroo – Health Plan
Keywords: Medicaid, Managed Care, Health Plan, Health Insurance, MCO, Integrated Case Manager, Registered Nurse, RN, Nursing, Fairfax, Springfield, and Alexandria, VA, Northern Virginia, NOVA, Long-Term Services and Supports (LTSS), Waiver, Home Health
Sentara Health is an equal opportunity employer and 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.
In support of our mission “to improve health every day,” this is a tobacco-free environment.
For positions that are available as remote work,Sentara Health employs associates in the following states:
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.
Sentara Health, an integrated, not-for-profit health care delivery system, celebrates more than 135 years in pursuit of its mission - "we improve health every day." Sentara is one of the largest health systems in the U.S. Mid-Atlantic and Southeast, and among the top 20 largest not-for-profit integrated health systems in the country, with 34,000 employees, 12 hospitals in Virginia and Northeastern North Carolina, including 10 hospitals with the prestigious Magnet®️ recognition, and the Sentara Health Plans division which serves more than 1 million members in Virginia and Florida. Sentara is recognized nationally for clinical quality and safety and is strategically focused on innovation and creating an extraordinary health care experience for our patients and members. Sentara was named a Health Quality Innovator of the Year (2024), was recognized by Forbes as "America’s Best-In-State Employer” (2024), "Best Employer for Veterans" (2022, 2023), and "Best Employer for Women" (2020), and named to IBM Watson Health's "Top 15 Health Systems" (2021, 2018).
Like us on Facebook at www.facebook.com/sentarahealth
Follow us on Instagram at @SentaraHealth
