What are the responsibilities and job description for the Integrated Case Manager - Registered Nurse position at Sentara?
Sentara Health Plan AvMed is looking to hire an Integrated Case Manager, RN.
This is a remote position; however, candidates must reside in Florida.
The Integrated 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 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. Ensure compliance with regulatory, accrediting and company policies and procedures. May assist in problem solving with provider, claims or service issues.
Demonstrates the minimum knowledge, skills and abilities to care for the individualized needs of the patient to include physical, psychological, socio-cultural, spiritual and cognitive needs as well as functional abilities including the need for diversified use of such practices. Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills
Education:
- Associates
- Bachelors preferred
Certification:
- Registered Nurse (required)
Experience:
- 3 years of nursing experience (required)
- Bilingual in Spanish (preferred)
- Managed care (preferred)
- Discharge planning experience (preferred)
Keywords: Talroo- Health, Case Management, Managed Care, Discharge Planning Asthma, Chronic Obstructive Pulmonary Disease (COPD), Diabetes, Coronary Artery Disease (CAD), Congestive Heart Failure (CHF)
Salary : $1,000 - $1,000,000