Registered Nurse (RN) Case Manager

Inova • Leesburg, VA

19h • Onsite

About The Position

Inova Loudoun Hospital is seeking a Registered Nurse Case Manager 1 for its Case Management Team. The role provides discharge planning and continuity of care for assigned patients in acute and post-acute settings, coordinates services, and serves as a liaison among patients, families, and interdisciplinary healthcare team members. The case manager uses utilization management techniques to assess the medical necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities; supports regulatory compliance and precertification and payer authorization processes; and participates in clinical performance improvement activities.

The position works with patients, families, and care teams to assess clinical and psychosocial needs, coordinate care and transitions, address barriers to care progression, and ensure that care and discharge plans meet patients’ physical, social, and emotional needs. It also monitors care plans, resource use, length of stay, and outcomes, and documents relevant information according to department standards. This is a full-time role, Monday through Friday, with rotating weekends.

Requirements

• Basic Life Support certification.
• Licensed or eligible for licensure in the Commonwealth of Virginia as a Registered Nurse, or an active multi-state Registered Nurse license.
• At least 1 year of case management and/or clinical care experience.
• Bachelor’s Degree in Nursing or Associate’s Degree. Applicants with an Associate’s Degree must, within 2 years of hire, meet with their nurse leader, identify an accredited school, provide a written plan with an anticipated BSN completion date, and submit a transcript review showing prerequisites and course timeline; the BSN must be completed within 5 years of the start date.

Nice To Haves

• One year of previous inpatient (hospital) case management experience and case management discharge planning is highly preferred.

Responsibilities

• Collect delay and other data for performance and outcome indicators.
• Assist in collecting and reporting resource and financial indicators, including case mix, length of stay, cost per case, excess days, resource utilization, readmission rates, denials, and appeals.
• Collect, analyze, and address variances from care plans and care paths with physicians and other healthcare team members; use concurrent variance data to support practice changes and improve outcomes.
• Document clinical pathway variances and outcomes related to areas of responsibility, and use pathway data with other disciplines to support effective patient management.
• Adhere to policies, procedures, and standards while ensuring safe care and managing time, supplies, productivity, and accuracy of practice.
• Meet mandatory and continuing education and competency requirements, and support department goals.
• Provide discharge planning and continuity of care for assigned patients in acute and post-acute settings.
• Initiate and facilitate referrals to clinics, home healthcare, hospice, skilled nursing facilities, acute rehabilitation, long-term acute care, transitional care management, and medical equipment and supply services as indicated.
• Coordinate discharge planning and post-discharge services and transitions with the interdisciplinary healthcare team, patients, and families, including ongoing care in the community.
• Document relevant discharge planning information in medical records according to department standards and care management plans.
• Collaborate and communicate with internal and external case managers, and maintain understanding of pre-acute and post-acute resources.
• Coordinate services and act as a liaison between patients, families, and interdisciplinary healthcare team members.
• Work with patients’ healthcare teams to manage and coordinate care holistically, addressing patients’ physical, social, and emotional needs.
• Provide educational resources or referrals to patients and families to address identified social or financial needs.
• Advocate for patients and help resolve barriers to care progression.
• Discuss payer criteria and issues with clinical staff and follow up with payers to resolve problems as needed.
• Apply approved clinical criteria to monitor the appropriateness of admissions, continued stays, and post-acute settings; document findings according to department standards.
• Identify at-risk populations using approved screening tools and established reporting procedures.
• Monitor length of stay and ancillary resource use, and take action to improve efficiency.
• Refer cases and issues appropriately to resolve barriers to care progression.
• Assess clinical and psychosocial needs through review of patient information and contact with patients, families, and interdisciplinary team members.
• Communicate routinely about care plan status, treatment goals, concerns, problem solving, and conflict resolution with patients, families, healthcare team members, and other appropriate parties.
• Work with the multidisciplinary team to resolve system problems that impede diagnostic or treatment progress; seek consultation as required to expedite care and facilitate discharge.
• Ensure critical elements of care plans are communicated to patients, families, and healthcare team members.

Benefits

• Medical, dental, and vision coverage.
• Team member wellness program.
• 401(k) matching: Inova matches 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: Entry Level