Integrated Nurse Case Manager

Sentara Health Plans is hiring an Integrated Nurse Case Manager/RN/Maternity/OBGYN for Lexington, Buena Vista, Millboro, Goshen, Warm Springs, McDowell and surrounding areasThis 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 areasStatus: Full-time, permanent position (40 hours) Standard working hours: 8am to 5pm EST, M-F Location: Applicants must be reside in Lexington, Buena Vista, Millboro, Goshen, Warm Springs, McDowell and surrounding areasPrimary 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 continuumPerforms 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 servicesIdentifies members for high-risk complications and coordinates care in conjunction with the member and health care teamManages chronic illnesses, co-morbidities, and/or disabilities ensuring cost effective and efficient utilization of health benefits; conducts gap in care management for quality programsAssists with the implementation of member care plans by facilitating authorizations/referrals within benefits structure or extra-contractual arrangements, as permissibleInterfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on care management treatment plansPresents cases at case conferences for multidisciplinary focus. Ensures compliance with regulatory, accrediting and company policies and proceduresMay assist in problem solving with provider, claims or service issues.Education:Associate or Bachelors Degree in Nursing REQUIREDCertification/Licensure:Registered Nurse (RN) License (Compact or Virginia) REQUIREDExperience:3 years experience in Nursing REQUIREDCase Management experience preferredManaged Care or Health Plan experience preferredExperience working with low and high risk pregnant population/Maternity/OB/L&D/Mother Baby/Postpartum experience preferredStrong knowledge of physical, psychological, socio-cultural, and cognitive patient needs.Excellent communication skills, both oral and written, as well as strong problem-solving and analyticalSentara 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 servicesu2014all 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 serveTo apply, please go to and use the following as your Keyword Search: JR-89064#IndeedTalroo - NursingCare 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, McDowellWe provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for Full Time employment is:$66,830.40-$111,384.00. Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Created: 2025-11-03