Integrated Nurse Care Manager- Remote VA

City/State

Work Shift

Overview:

Sentara Healthcare is currently hiring an Integrated Nurse Case Manager for the Eastern Middle Peninsula region of VA!

This is a Full Time position with day shift hours and great benefits!

The Integrated Care Manager (ICM) is a Registered Nurse Clinician responsible for providing comprehensive case management services to a defined high-risk member population. This role focuses on supporting individuals with complex care needs and aims to optimize health outcomes through proactive coordination, care planning, and resource management across the care continuum.

Target Member Population Includes:

• High Emergency Room (ER) utilizers

• Recent hospital discharges

• Members diagnosed with heart failure, COPD, or diabetes

• Individuals with Developmental Disability (DD) waivers

Key Responsibilities:

• Perform telephonic and/or face-to-face clinical assessments to identify, evaluate, and manage member needs, including medical, behavioral health, social, and long-term care services

• Develop, monitor, evaluate, and revise individualized care plans tailored to member needs and health goals

• Identify members at risk for complications or re-hospitalizations and coordinate timely interventions with the member, caregiver, and health care team

• Support management of chronic illnesses, co-morbidities, and disabilities, ensuring appropriate utilization of benefits and adherence to care plans

• Conduct gap in care management as part of quality improvement initiatives

• Facilitate necessary authorizations and referrals within benefit guidelines or through extra-contractual arrangements when appropriate

• Collaborate with Medical Directors, Physician Advisors, and Interdisciplinary Teams to review and align on care plans and treatment recommendations

• Present member cases in case conferences to ensure a multidisciplinary approach to care

• Ensure all activities are compliant with regulatory standards, accreditation requirements, and company policies

• Assist in resolving provider, claims, or service-related issues impacting member care

Education

• Associates or Bachelors Degree in Nursing

Certification/Licensure

• Registered Nurse License (RN) - Nursing License - Compact/Multi-State License required.

Experience

• 3 years experience in Nursing

• Strong background in case management, including the ability to develop, monitor, and revise individualized care plans for complex member populations.

• Experience working with high-risk members, such as those with: Frequent ER utilization / Recent hospital discharges / Chronic conditions (e.g., heart failure, COPD, diabetes)/ Individuals with Developmental Disability (DD) waivers.

• Ability to collaborate with interdisciplinary teams, including physicians, social workers, and behavioral health professionals

• Excellent communication, critical thinking, and organizational skills

• Demonstrated flexibility and adaptability in a field-based role with travel requirements

Keywords: Care Coordination, Case Management, Human Services, Community Health, Health Education, RN Case Manager, LinkedIn, Talroo-Nursing, ER utilization , discharges, heart failure, COPD, diabetes), Developmental Disability (DD) waivers.

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.