Registered Nurse (RN) Case Manager

Inova • Leesburg, VA

1d • $86,091 - $140,338

About The Position

Inova Loudoun Hospital is seeking a full-time Registered Nurse Case Manager to join its Case Management Team. The position 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 role uses utilization management techniques to assess the medical necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities. It also supports timely regulatory compliance and facilitates precertification and payer authorization when indicated, while participating in clinical performance improvement activities.

The Case Manager assesses patients’ clinical and psychosocial needs, coordinates care and discharge plans, arranges referrals and post-discharge services, and helps address barriers to care progression. The role monitors utilization, length of stay, outcomes, and variances from care plans, collaborating with clinical teams and payers to support effective, safe, and efficient care. The schedule is 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 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. An RN with an Associate’s degree must meet with their nurse leader within 2 years of hire, 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 (hospital) case management experience and case management discharge planning is highly preferred.

Responsibilities

• Collect and analyze delay, resource, financial, performance, and outcome data, including case mix, length of stay, cost per case, excess days, resource utilization, readmissions, denials, and appeals.
• Review variances from plans of care and care paths with physicians and other healthcare team members, use concurrent variance data to drive practice changes, and document relevant variances and outcomes.
• Coordinate safe, effective patient management using pathway data in collaboration with other disciplines.
• 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, LTAC, TCM, and medical equipment and supplies as indicated.
• Collaborate with patients, families, and interdisciplinary healthcare teams to assess discharge needs, coordinate services, and support transitions from hospital to discharge setting and ongoing community care.
• Document discharge planning information in medical records according to department standards and care management plans.
• Communicate and coordinate with internal and external case managers, patients, families, and healthcare team members, acting as a liaison and addressing patients’ physical, social, and emotional needs.
• Provide educational resources or referrals to patients and families for identified social or financial needs, and advocate for patients to resolve barriers to care progression.
• Use utilization management techniques and approved clinical criteria to assess medical necessity and the appropriateness of admissions, continued stays, and post-acute settings; document findings.
• Discuss payer criteria and issues with clinical staff and follow up with payers to resolve problems as needed.
• Identify at-risk populations using approved screening tools and follow established reporting procedures.
• Monitor length of stay and ancillary resource use, take action to improve efficiency, and refer cases or 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 care-plan status and progress toward treatment goals, identify concerns, assist with problem solving and conflict resolution, and work with multidisciplinary teams to resolve system problems affecting diagnostic or treatment progress.
• Seek consultation from appropriate disciplines or departments to expedite care and facilitate discharge, and ensure critical care-plan information is communicated to patients, families, and healthcare team members.
• Adhere to policies, procedures, and standards within budgetary specifications, including time management, supply management, productivity, and accuracy of practice.
• Meet mandatory and continuing education and skills competency requirements, and support department goals.

Benefits

• Medical, dental, and vision coverage.
• Team member wellness program.
• Retirement plan with Inova 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 no-cost mental health coaching or therapy sessions per person per year 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