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

City/State

Work Shift

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  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

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  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

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  Identifies members for high-risk complications and coordinates care in conjunction with the member and health care team

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  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

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  Assists with the implementation of member care plans by facilitating authorizations/referrals within benefits structure or extra-contractual arrangements, as permissible

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  Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on care management treatment plans

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  Presents cases at case conferences for multidisciplinary focus. Ensures compliance with regulatory, accrediting and company policies and procedures

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  May assist in problem solving with provider, claims or service issues.

• High Emergency Room (ER) utilizers

• Recent hospital discharges

• Members diagnosed with chronic/complex conditions (Asthma, diabetes, heart failure, cancer, heart disease, COPD)

• Associate or Bachelors Degree in Nursing REQUIRED

• Registered Nurse (RN) License (Compact or Virginia) REQUIRED

• 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

Talroo – Health Plan

Managed Care, MCO, Health Plan, Healthcare, Health Insurance, Nursing, RN, Registered Nurse, Medicaid, Chronic, Complex condition members, Asthma, diabetes, heart failure, cancer, heart disease, COPD, home health experience, inpatient case management, hospice, emergency room, ED, Emergency Department, Discharge Planning, Case Management, Transition of Care, TOC, Virginia Fredericksburg, Spotsylvania, VA, Remote, Virginia

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