Integrated Nurse Case Manager In Northern Virginia

This position is in Northern Virginia and does require face to face visits with members.

NICU or Peds is beneficial for this position

• Registered Nurse License (RN) - Virginia
• Registered Nurse License (RN) - North Carolina
• Registered Nurse License (RN) - Compact/Multi-State License

The Northern Virginia located Registered Nurse Clinician 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 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.

• Requires an RN; BSN preferred
• NICU or Peds is beneficial for this position

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

• Bachelor's Level Degree
• Associate's Level Degree
• Bachelor's Level Degree

• Managed Care 2 years
• Nursing 3 years
• Discharge Planning Previous Experience

• Critical Thinking
• Service Orientation
• Microsoft Office
• Complex Problem Solving
• Communication
• Judgment and Decision Making