Case Management Program Manager

Inova • Falls Church, VA

1d • $100,443 - $163,717

About The Position

Inova Fairfax Hospital is seeking an experienced Case Management Program Manager to join its Case Management Team. This full-time, day-shift role is scheduled Monday through Friday, 8:30 a.m. to 5:00 p.m., with rotating weekend and holiday coverage. The manager serves as a resource to discharge planners and the multidisciplinary team, supports care coordination and discharge planning, and helps ensure continuity, quality, and safe delivery of patient care. The position also monitors unit service quality and performance measures, including clinical and financial indicators.

Requirements

• Basic Life Support certification required upon start.
• Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification required upon start.
• Must have a master's degree in Social Work or be a Registered Nurse in Virginia.
• Bachelor of Science in Nursing (BSN) or Master of Social Work (MSW).
• Five years of acute-care case management experience in an acute healthcare environment.

Nice To Haves

• Five or more years of inpatient hospital case-management experience, including discharge planning.
• Supervisory or leadership experience.
• Experience working with medically complex cases.

Responsibilities

• Provide guidance, training, consultation, and case-management support to discharge planners and the multidisciplinary team; participate in multidisciplinary rounds and manage assigned patients.
• Promote continuity of care by reviewing patient assessments and information, arranging appropriate referrals for social determinants of health needs, and identifying at-risk populations using approved screening tools and reporting procedures.
• Initiate and facilitate referrals to specialists, clinics, home healthcare, hospice, skilled nursing facilities, acute rehabilitation, long-term acute care, transitional care management, and medical equipment and supplies as indicated.
• Communicate with patients, families, interdisciplinary healthcare team members, and other appropriate parties about care plans, treatment progress, concerns, problem-solving, and conflict resolution; address system issues impeding diagnosis or treatment and document as needed.
• Consult with appropriate disciplines and departments to expedite care and facilitate discharge.
• Communicate with payers and other required parties to ensure reimbursement certification; discuss payer criteria and case-specific issues with discharge planners and clinical staff, and follow up to resolve payer problems.
• Collaborate with discharge planners, healthcare team members, patients, families, and internal and external case managers to assess and coordinate care and discharge-planning needs.
• Ensure safe patient care in accordance with policies, procedures, and standards, while meeting budgetary specifications for time and supply management, productivity, and practice accuracy.
• Collect and report resource and financial indicators, including case mix, length of stay, cost per case, excess days, resource utilization, readmission rates, denials, and appeals.
• Serve on agency committees, work groups, and other bodies.
• Oversee quality assurance for unit service delivery, including clinical care and documentation; identify and address variances from plans of care and care paths with physicians or other healthcare team members, and collect delay, quality, and other performance or outcome data.
• Perform additional duties as assigned.

Benefits

• Medical, dental, and vision coverage.
• Team member wellness program.
• Retirement plan with Inova matching the first 5% of eligible contributions, starting on the first day.
• Education assistance of up to $5,250 per year.
• Student loan assistance of up to $10,000.
• Up to 25 mental health coaching or therapy sessions per person per year at no cost for team members, their spouses or partners, and their children.
• Paid time off.
• Paid parental leave.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager