Department and Name: Chronic Disease Management – SHP VA- Health Plan
Sentara Facility: Virginia Remote
Physical Location: Norfolk, VA
Location Type: Remote
Employment Status: Regular-Full time
Shift: First (Days)
Posted Date: July 10, 2025
Sentara Health Plans is hiring an Integrated Nurse Case Manager/RN for Chronic Disease Management – Remote in VA!
Status: Full-time, permanent position (40 hours)

EDUCATION:

• Bachelors Degree in Nursing preferred

PREFERRED QUALIFICATIONS:

• 3 years experience in Nursing REQUIRED
• Case Management experience preferred
• Discharge planning experience preferred
• Managed Care or Health Plan experience preferred
• Chronic Disease Management experience for Medicaid, Medicare and DSNP members preferred
  Sentara 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 services—all 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.

• 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.