Patient Care Coordination Manager

Inova•Falls Church, VA

3d•$33 - $54•Remote

About The Position

The Manager of Patient Care Coordination facilitates and oversees complex care plans and the delivery of healthcare services for patients throughout the continuum of care. The role advocates for patients’ welfare and appropriate service utilization, provides timely referral management based on individual needs, and supports patients and families through emotional support, counseling, clinical education, resources, and expert guidance. The manager helps patients and families understand and participate meaningfully in healthcare and personal decision-making. The position is remote, with on-site attendance required for the first three months of training. The stated schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m.

Requirements

Basic Life Support (BLS) certification required upon start.
Three years of progressive experience in care or disease management, including coordinating patient care and population health programs.
Bachelor’s degree in social work (BSW), health, human social services, or a related field.

Nice To Haves

Certified Dementia Practitioner (CDP) certification required within one year of hire, as stated under preferred qualifications.
At least three years of patient care coordination experience.
Knowledge of commercial insurance, Medicare, and Medicaid.
Preferably three or more years of experience in adult care or geriatrics.

Responsibilities

Identify appropriate patient care opportunities and determine patient eligibility for prevention and diagnostic or clinical treatments.
Collaborate with the multidisciplinary team to address patient questions about care processes and treatment options.
Develop individualized patient care support by facilitating appointment scheduling, assisting with referrals, and providing information and advocacy throughout the care process.
Follow health information system workflows to identify, monitor, and document care management across the healthcare continuum, including primary, secondary, and tertiary care.
Partner with community-based organizations to improve the continuum of care for specific patient populations.
Provide timely referral and transition management support based on individual patient needs.
Liaise with community services for individuals seeking screening, diagnostic treatment, or support services.
Design and implement transitional plans that facilitate seamless movement to the next level of care.
Educate patients, families, caregivers, and healthcare delivery team members about treatment options, community resources, insurance benefits, self-care management, and other matters supporting timely and informed decisions throughout the continuum of care.
Perform other duties as assigned.