Virginia Beach, VA
Aug 30, 2018
Sep 21, 2018
Full Time
Job Description: Responsible and accountable for the provision and facilitation of comprehensive care coordination services and quality outcomes for patients across the continuum. Promotes effective utilization and monitoring of health services, collaborates and communicates with the healthcare team and patient/caregiver to manage care and transitions. Develops and/or implements a comprehensive care plan based on assessment and evaluation of patient/caregiver needs. Functions in one of the following practice settings: Acute Care, Service Lines, Ambulatory/Community-based, Home Health, and Long Term Care. Education Level
RN-Bachelor's Level Degree

Required: Nursing - 3 years

Preferred: None, unless noted in the “Other” section below

Required: Registered Nurse

Preferred: Basic Life Support

Required: Communication, Critical Thinking, Service Orientation

Preferred: None, unless noted in the “Other” section below

BLS (if in a clinical setting). For Integrated Care Management departments, specialty certification required within one year of eligibility (ACM, CCM, CCCTM or RN-BC). For other service lines, certification based on specialty area required within one year of eligibility. 3 years Case Management experience preferred. For those in Behavioral Health - Certification in de-escalation training within 15 days of hire and annually. PACE specific incumbents for this position require a minimum of one year of experience working with the frail or elderly population.

Optima Health is hiring a Registered Nurse (RN), Integrated Care Manager - Research, in Virginia Beach, VA. This position is full time, day shift (Monday - Friday, 8am-5pm)

The selected RN for this position will be responsible for compliance with NCQA timeliness parameters for processing complex authorization requests, the denial letter process, and reconsideration process. Ensures authorization compliance with Department of Labor, OHP contract requirements, Virginia Medicaid and FAMIS, collaborates with members and providers to facilitate care in the most cost effective setting. Assumes responsibility for making coverage/denial recommendations for the Optima Medical Director. Serves as subject matter expert for medical benefit drug authorizations, ensures sufficient research and compliance with medical benefit drug parameters are met, works collaboratively with the OHP pharmacists to ensure member meets Optima medical necessity criteria. This position is to support Medicaid Expansion. Minimum BSN degree required and at least 3 years of RN experience.

As a nationally recognized provider of health plan coverage and innovative wellness programs, we live our mission “to improve health everyday.” This same commitment and dedication directs our philosophy as an employer. When you join Optima Health, you will experience our deep passion for heal and service excellence while benefiting from a culture of opportunity, learning, career growth, and support -every day. Optima Health is a service of Sentara Healthcare, so joining Optima is joining the Sentara Healthcare family.

Sentara employees strive to make our communities healthier places to live. We're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For more information about our employee benefits, CLICK HERE!

Join our team, where we are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, growth!

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