Integrated Nurse Case Manager, Registered Nurse, RN – Chronic/Complex Condition

This is a fully remote position, open to applicants in Virginia.

📋 Description

• Deliver case management services within the scope of your licensure.

• Create, monitor, assess, and adjust member care plans to enhance healthcare throughout the care continuum.

• Conduct both telephonic and in-person clinical assessments.

• Identify, assess, coordinate, and manage members’ physical, behavioral, social-service, and long-term-service requirements.

• Recognize members at risk for complications and collaborate on care with members and healthcare teams.

• Oversee chronic illnesses, comorbidities, and disabilities to ensure cost-effective use of health benefits.

• Execute gap-in-care management for quality improvement programs.

• Facilitate authorizations and referrals within the benefits framework or allowable extra-contractual arrangements.

• Collaborate with Medical Directors, Physician Advisors, and interdisciplinary teams on care-management treatment strategies.

• Present cases during multidisciplinary case conferences.

• Ensure adherence to regulatory, accrediting, and company policies and procedures.

• Aid in resolving provider, claims, or service-related issues.

• Perform at least 12 face-to-face home visits each month.

⛳️ Requirements

• Associate or Bachelor’s Degree in Nursing is mandatory.

• A Registered Nurse (RN) License, either Compact or Virginia, is required.

• A minimum of 3 years of nursing experience is essential.

• Previous case management experience is highly preferred.

• Experience in Managed Care or Health Plan is preferred.

• Familiarity with working with members who have chronic or complex conditions is preferred.

• Background in home health, inpatient case management, hospice, transition of care, and discharge planning is preferred.

• Strong understanding of physical, psychological, socio-cultural, and cognitive patient needs.

• Outstanding oral and written communication skills.

• Excellent problem-solving and analytical abilities.

• Must reside in Hampton, Newport News, Yorktown, Williamsburg, Virginia, or nearby areas.

• Availability to work from 8 a.m. to 5 p.m. EST, Monday through Friday.

• Willingness to travel for face-to-face home visits.

🏝️ Benefits

• Medical, Dental, and Vision plans.

• Adoption, Fertility, and Surrogacy Reimbursement up to $10,000.

• Paid Time Off and Sick Leave.

• Paid Parental & Family Caregiver Leave.

• Emergency Backup Care.

• Long-Term, Short-Term Disability, and Critical Illness plans.

• Life Insurance.

• 401k/403B with Employer Match.

• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education.

• Student Debt Pay Down – $10,000.

• Reimbursement for certifications and complimentary access to complete CEUs and professional development.

• Pet Insurance.

• Legal Resources Plan.

• Annual discretionary bonus if established system and employee eligibility criteria are met.

• Work-from-home position.

• Opportunities for professional development and a commitment to continuous employment philosophy.