Integrated Nurse Case Manager/Registered Nurse/RN for Chronic/Complex Condition in Fredericksburg, S

Status: Full-time, permanent position (40 hours) Standard working hours: 8am to 5pm EST, M-F

Location: Applicants must reside in Fredericksburg, Spotsylvania, VA and the surrounding areas!

Primary responsibilities include: 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.

Target Member Population Includes: High Emergency Room (ER) utilizers Recent hospital discharges Members diagnosed with chronic/complex conditions (Asthma, diabetes, heart failure, cancer, heart disease, COPD)

Education: Associate or Bachelors Degree in Nursing REQUIRED

Certification/Licensure: Registered Nurse (RN) License (Compact or Virginia) REQUIRED

Experience: 3 years experience in Nursing REQUIRED Case Management experience highly preferred Managed Care or Health Plan experience preferred Experience working with chronic/complex condition members (Asthma, diabetes, heart failure, cancer, heart disease, COPD) preferred Experience in home health experience, inpatient case management, hospice, transition of care, and discharge planning preferred Strong knowledge of physical, psychological, socio-cultural, and cognitive patient needs. Excellent communication skills, both oral and written, as well as strong problem-solving and analytical