Case Management Specialist

Inova • Falls Church, VA

3d • $21 - $35

About The Position

Inova Fairfax Hospital is seeking a full-time Case Management Specialist to coordinate and perform administrative activities supporting the Case Management department. The role arranges services for assigned patient populations—including home health, durable medical equipment, ambulance, housing, and skilled nursing facility services—to ensure appropriate continuing care services are in place for patient transitions. It communicates and documents clinical and financial information to support Case Managers and Social Workers in assessing, implementing, and evaluating patients’ continuing care needs. The Specialist also delivers and documents mandated regulatory notices and receives and documents benefit and contract requirements to support appropriate use of benefits and services.

The position supports the department’s financial, operational, and administrative functions, including budget processes, accounts receivable and payable, vendor contract reimbursement, time and attendance reviews, and record maintenance. The schedule is Monday through Friday, 40 hours per week, with rotating weekends every four to five weeks.

Requirements

• High school diploma or equivalent.
• Two years of relevant experience.

Nice To Haves

• Associate's or bachelor's degree.
• Healthcare experience.

Responsibilities

• Coordinate and perform administrative activities to support the Case Management department.
• Participate in annual and ongoing budget processes and assist with monitoring and reconciling the operational budget in collaboration with the department Director.
• Arrange services for assigned patient populations, including home health, durable medical equipment, ambulance, housing, and skilled nursing facility services.
• Communicate and document accurate clinical and financial information to support patient assessments, care planning, and transitions to continuing care services.
• Deliver and document mandated Observation, Medicare IMM, and HINN letters as directed.
• Receive and document benefit and contract-level requirements to support appropriate utilization of benefits and services.
• Arrange services promptly to meet customer requirements and address provider and payor issues with support from Case Management staff.
• Communicate financial and clinical information to clinicians, patients, families, care team members, and external customers.
• Communicate with payors and document detailed billing, authorization, and service-utilization instructions.
• Complete state and federal forms related to patient level of care according to regulatory standards.
• Manage and maintain state-required UAI filings and departmental accounts receivable and payable functions.
• Maintain and monitor the system Case Management program, including reimbursement of negotiated vendor contracts.
• Support the department’s strategic planning and business development initiatives.
• Review and approve department staff time and attendance biweekly; periodically track attendance and submit identified time or pay adjustments to Payroll.
• Maintain system Case Management files and act as liaison to the Foundation, auxiliary, and external vendors.
• Track and monitor budgets, capital requests, travel funds, and business expenses.
• Perform other duties as assigned.

Benefits

• Medical, dental, and vision coverage.
• Team member wellness program.
• Retirement plan 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.
• Flexible work schedules.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED