Case Management Program Manager

Inova Health; Falls Church (VA); On-site; USD 95,000 - 125,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Wellness program

Retirement matching (5%)

Education assistance up to $5,250/year

Student loan repayment up to $10,000

Mental health support

Job summary

Inova Fairfax Hospital is seeking an Experienced Case Management Program Manager to join the Case Management Team. This full-time, day-shift role supports discharge planning, care coordination, and patient-centered outcomes.

The role emphasizes collaboration with physicians, nurses, social workers, and other professionals to optimize transitions, address Social Determinants of Health, and ensure timely, quality care for diverse patient populations.

Qualifications

• Master's Degree in Social Work or RN licensure in Virginia is required.
• BLS certification required on start or by start date.
• At least 5 years of acute care case management experience in a hospital setting.

Responsibilities

• Guide discharge planners and multidisciplinary team through care transitions.
• Ensure continuity of care, assess patient needs, and coordinate referrals for Social Determinants of Health (SDOH).
• Initiate referrals to specialists, clinics, home health, hospice, SNF, rehab, and equipment as needed.
• Communicate with patients, families, and healthcare staff about care plans, progress, and concerns; resolve issues.
• Consult with appropriate disciplines to expedite care and discharge planning.
• Interface with payers to secure reimbursement certification for assigned patients and resolve payer issues.
• Collaborate with DCP and care teams to coordinate all areas of discharge planning.

Education

Master's Degree in Social Work or licensed RN in Virginia

Certification: Basic Life Support (BLS)

5 years acute care case management experience

Job description

Inova Fairfax Hospital is looking for a dedicated Experienced Case Management Program Manager to join the Case Management Team. This role will be Full-Time, Day shift: Monday - Friday 8:30 am - 5:00pm with rotating weekends and holiday rotation schedule.

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.

Featured Benefits:

• Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
• Retirement: Inova matches the first 5% of eligible contributions - starting on your first day.
• Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
• Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
• Work/Life Balance: offering paid time off, paid parental leave

Case Management Program Manager Job Responsibilities:

• Serves as resource for discharge planners (DCP) and the multi-disciplinary team through guidance, training, consultation, participating in Mulit-Disciplinary Rounds (MDRs), and managing assigned patients.
• Ensures continuity of care in the provision of comprehensive services. Reviews patient assessments and information, ensures appropriate referrals for Social Determinants of Health (SDOH) patient/family needs, and identifies at risk populations by using approved screening tools and following established reporting procedures.
• Initiates and facilitates referrals to specialists, clinics, home healthcare, hospice, SNF, acute rehab, LTAC, TCM, medical equipment and supplies as indicated.
• Communicates routinely with patients, families, interdisciplinary healthcare team members and other appropriate parties with regard to the status of patients' care plans, progress toward treatment goals, identification of concerns/problems, problem solving and assisting with conflict resolution when necessary. Addresses/resolves system problems impeding diagnostic or treatment progress, documents as necessary to ensure continuity of care.
• Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.
• Communicates with payers or required parties to ensure reimbursement certification for assigned patients and discusses payer criteria with the Discharge Planner and issues on a case by case basis with clinical staff and follows-up to resolve problems with payers as needed.
• Works closely with Discharge Planners (DCP), members of patients' healthcare teams to manage and coordinate all areas of care and collaborates with the DCP, interdisciplinary care teams, patients and families in the assessment and coordination of discharge planning needs; collaborating with internal and external case managers.
• Ensures safe care to patients by adhering to policies, procedures and standards, within budgetary specifications including time/supply management, productivity and accuracy of practice.
• Collects and reports resource and financial indicators including clinical metrics case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals.
• Serves on agency committees, work groups, and other bodies.
• Responsible for quality assurance in the unit's service delivery including clinical care and documentation. Collects, analyzes and addresses variances from plans of care and care paths with physicians and/or other members of the healthcare team, and collects delay and other data, as well as quality metrics, for specific performance and/or outcome indicators.
• Performs additional duties as assigned.

Minimum Qualifications:

• Certification: Basic Life Support - upon start, One of the following required: Accredited Case Manager (ACM) or Certified Case Manager (CCM) - upon start
• Licensure: Must have a Master's Degree in Social Work or be a Registered Nurse in Virginia
• Experience: 5 years of acute care case management experience in an acute healthcare environment
• Education: BSN or MSW

Preferred Qualifications:

• Five (5) + years of previous Inpatient (hospital) case management experience, case management discharge planning, and supervisory/lead experience is highly preferred. Previous experience working through medically complex cases is also highly preferred.