Case Management Program Manager (Registered Nurse OR Social Worker)

Inova • Falls Church, VA

6d • Hybrid

About The Position

Inova Fairfax Hospital is seeking an experienced Case Management Program Manager to join their Case Management Team. This role is a Full-Time, Day shift position, Monday - Friday, 8:30 am - 5:00 pm, with a rotation every 3rd weekend and holiday schedule. The position offers hybrid capabilities. Inova is recognized as a national healthcare leader in safety, quality, and patient experience, and is a consistently recognized top employer. Inova Fairfax Hospital has achieved Magnet® designation from the American Nurses Credentialing Center (ANCC), a five-star rating from CMS, recognition as one of the nation's highest performing hospitals by IBM Watson Health, an A for Patient Safety by The Leapfrog Group, and is ranked #1 in the DC metro area by U.S. News & World Reports.

Requirements

• Bachelor's Degree in Nursing or Master's Degree in Social Work.
• Minimum of five (5) years acute care case management experience in an acute healthcare environment.
• Demonstrated understanding of DCP for specific disease states.
• Understanding of Social Determinants of Health (SDOH) impact on health.
• Must be licensed in the Commonwealth of Virginia to practice as a Registered Nurse (RN).
• Basic Life Support (BLS) for Healthcare Provider certification from the American Heart Association required upon start.
• Must have one of the following: Accredited Case Manager (ACM) or Certified Case Manager (CCM) upon start.

Nice To Haves

• Five (5) + years of previous Inpatient (hospital) case management experience.
• Case management discharge planning experience.
• Supervisory/lead experience.
• Previous experience working through medically complex cases.

Responsibilities

• Serves as a resource for discharge planners (DCP) and the multi-disciplinary team through guidance, training, consultation, participating in Multidisciplinary Rounds (MDRs), and managing assigned patients.
• Ensures continuity of care in the provision of comprehensive services. Reviews patient assessments and information, ensures appropriate referrals for Social Determinants of Health (SDOH) patient/family needs, and identifies at-risk populations by using approved screening tools and following established reporting procedures.
• Initiates and facilitates referrals to specialists, clinics, home healthcare, hospice, SNF, acute rehab, LTAC, TCM, medical equipment and supplies as indicated.
• Communicates routinely with patients, families, interdisciplinary healthcare team members and other appropriate parties regarding the status of patients' care plans, progress toward treatment goals, identification of concerns/problems, problem-solving, and assisting with conflict resolution when necessary. Addresses/resolves system problems impeding diagnostic or treatment progress, documents as necessary to ensure continuity of care.
• Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.
• Communicates with payers or required parties to ensure reimbursement certification for assigned patients and discusses payer criteria with the Discharge Planner and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payers as needed.
• Works closely with Discharge Planners (DCP), members of patients' healthcare teams to manage and coordinate all areas of care and collaborates with the DCP, interdisciplinary care teams, patients and families in the assessment and coordination of discharge planning needs; collaborating with internal and external case managers.
• Ensures safe care to patients by adhering to policies, procedures and standards, within budgetary specifications including time/supply management, productivity and accuracy of practice.
• Collects and reports resource and financial indicators including clinical metrics case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals.
• Serves on agency committees, work groups, and other bodies.
• Responsible for quality assurance in the unit's service delivery including clinical care and documentation. Collects, analyzes and addresses variances from plans of care and care paths with physicians and/or other members of the healthcare team, and collects delay and other data, as well as quality metrics, for specific performance and/or outcome indicators.
• Performs additional duties as assigned.

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Robust team member wellness program
• Inova matches the first 5% of eligible contributions for retirement
• Up to $5,250 per year in education assistance
• Up to $10,000 for student loans
• 25 mental health coaching or therapy sessions per person, per year, at no cost for team members, spouses/partners, and children
• Paid time off
• Paid parental leave
• Flexible work schedules

What This Job Offers

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