Registered Nurse (RN) Case Manager

Inova • Alexandria, VA

2d • $86,091 - $140,329

About The Position

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

The RN Case Manager works with patients, families, and multidisciplinary teams to assess clinical and psychosocial needs, coordinate care, address barriers to care progression, and facilitate transitions to appropriate discharge settings and ongoing community care. The role monitors utilization and outcomes, documents care planning and clinical findings, and supports safe, efficient, and patient-centered care. The schedule is Monday through Friday with rotating weekends.

Requirements

• Basic Life Support certification from the American Heart Association.
• Licensed or eligible for licensure in the Commonwealth of Virginia as a Registered Nurse, or holds an active multistate Registered Nurse license.
• At least 1 year of case management and/or clinical care experience.
• Bachelor's degree in Nursing or an associate's degree. For an RN with an associate's degree, within 2 years of hire the employee must meet with their nurse leader, identify an accredited school, provide a written plan with an anticipated BSN completion date, submit a transcript review showing prerequisites and course timeline, and complete the BSN within 5 years of the start date.

Nice To Haves

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

Responsibilities

• Collect delay and performance or outcome data, including resource and financial indicators such as case mix, length of stay, cost per case, excess days, utilization, readmissions, denials, and appeals.
• Analyze variances from plans of care and care paths with physicians and other healthcare team members, using concurrent data to support practice changes and improve outcomes.
• Document clinical path variances, outcomes, and discharge-planning information in medical records according to department standards and care management plans.
• Use pathway data with other disciplines to support effective concurrent patient management and ensure safe, policy-compliant care within budgetary specifications.
• Meet mandatory and continuing education and skills competency requirements, support professional growth, and contribute to department goals.
• Provide discharge planning and continuity of care for 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 or supplies as indicated.
• Coordinate discharge planning, post-discharge services, and transitions from hospital to discharge settings and ongoing community care in collaboration with patients, families, and the interdisciplinary healthcare team.
• Coordinate services and communicate with internal and external case managers, patients, families, and interdisciplinary healthcare team members; address patients' physical, social, and emotional needs.
• Provide educational resources or referrals for identified social and financial needs and advocate for patients to resolve barriers to care progression.
• Apply utilization management techniques and approved clinical criteria to assess medical necessity and the appropriateness of admissions, continued stays, and post-acute settings; document findings and discuss payer criteria and issues with clinical staff.
• Identify at-risk populations using approved screening tools and reporting procedures; monitor length of stay and ancillary resource use and take action to improve efficiency.
• Refer cases and issues appropriately to address barriers to care progression.
• Assess clinical and psychosocial needs through review of patient information and contact with patients, families, and interdisciplinary team members.
• Communicate about care-plan status, progress toward treatment goals, concerns, and problems; assist with problem-solving and conflict resolution as needed.
• Work with multidisciplinary teams to resolve system problems that impede diagnostic or treatment progress, seek consultations as needed, and ensure critical care-plan information is communicated to patients, families, and healthcare team members.

Benefits

• Medical, dental, and vision coverage.
• Team member wellness program.
• Retirement plan match of the first 5% of eligible contributions, starting on the first day.
• Up to $5,250 per year in education assistance.
• Up to $10,000 in student loan assistance.
• 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: Mid Level
• Education Level: Associate degree