Integrated Care Manager - RN

Location
Virginia Beach, VA
Salary
Competitive
Posted
Apr 17, 2019
Closes
Apr 17, 2019
Ref
120836BR
Function
Nurse
Industry
Healthcare
Hours
Full Time
Qualifications

Education Level
RN-Associate's Degree OR
RN-Bachelor's Level Degree OR
RN-Diploma (Non-degree) OR
RN-Master's Level Degree

Experience
Required: Nursing - 3 years

Preferred: None, unless noted in the "Other" section below

License
Required: Registered Nurse

Preferred: Basic Life Support

Skills
Required: Communication, Critical Thinking, Service Orientation

Preferred: None, unless noted in the "Other" section below

Optima Health, Medical Care Services - Pre-authorization, Virginia Beach, has an opening for an Integrated Care Manager. This position is full time, day shift.

Integrated Care Manager Research is 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. Facilitates individual financial agreements to ensure cost effective care for OHP associates. Assumes responsibility for emerging technology reviews and makes coverage/denial recommendations to the Optima Medical Director.

Optima Health is a service of Sentara Healthcare, so joining Optima is joining the Sentara Healthcare family. Optima Health offers a full suite of commercial health insurance products including employee-owned and employer-sponsored plans, as well as Individual and Family health plans, employee assistance plans and plans serving Medicare and Medicaid enrollees. We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services.

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.

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!

Other
BLS (if in a clinical setting). All Registered Nurses who do not have their BSN will be required to sign a BSN Agreement committing to successfully obtain their BSN within 5 years of hire. BSN or MSN preferred.

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.

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