Patient Care Coordination Manager

Inova Health System; Falls Church (VA); Hybrid; USD 90,000 - 125,000; Full time

Job summary

Inova Health System is seeking a Manager of Patient Care Coordination to oversee comprehensive care plans for patients across the care continuum. You will advocate for patients, manage referrals, and guide families through decision-making with emotional and clinical support.

Responsibilities include coordinating appointments, documenting care workflows, partnering with community organizations, and educating patients on options, benefits, and resources for timely transitions across primary,

Qualifications

• 3 years of progressive experience with care or disease management, coordinating patient care and population health programs.
• Bachelor's in social work (BSW) or bachelor's in health, human social services, or related field.
• BLS certification required upon start.

Responsibilities

• Identify patient care opportunities and determine eligibility for treatments with the care team.
• Develop individualized patient care by coordinating appointments and referrals.
• Follow workflows in health information systems to document care management across the continuum.
• Collaborate with community organizations to improve care continuity for specific populations.
• Provide referral/transition support and liaison to community services.
• Educate patients and families about treatment options, resources, insurance, and self-care.

Skills

Care coordination

Population health

Referral management

Patient advocacy

Communication

Education

Bachelor's in social work (BSW) or related field

Job description

Remote (On-site for first three months of training required)

The Manager of Patient Care Coordination facilitates and oversees the complex care plan and delivery of healthcare services for patients throughout the continuum of care. Acts as an advocate for the welfare and appropriate utilization of services for patients. Provides effective and timely referral management support to patients based on individualized needs. Serves as an advisor by providing emotional support, counseling, clinical education, resources and expert guidance to patients and families to promote their ability to understand and participate meaningfully in the healthcare process and personal decision making.

Job Responsibilities

• Identifies appropriate patient care opportunities for patients and determines patients' eligibility for prevention and diagnostic/clinical treatments. Collaborates with the multidisciplinary team to address patient questions about the care process and treatment options.
• Develops individualized patient care for patients seeking treatment by facilitating appointment scheduling, assisting with referral the process and providing information and advocacy to patients throughout care process.
• Follows the workflows required by the health information systems used to identify, monitor and document the care management of patients through the entire healthcare continuum including primary, secondary and tertiary care.
• Works in partnership with community-based organizations to improve the continuum of care for specific patient populations.
• Provides effective and timely referral/transition management support to patients based on individualized needs.
• Serves as a Liaison to community services for individuals looking for screening, diagnostic treatment and/or support services.
• Provides seamless transitions, utilizing the entire continuum of care, by designing and implementing a transitional plan that facilitates patients' movement to the next level of care.
• Educates patients, families, caregivers and members of the healthcare delivery team regarding treatment options, community resources, insurance benefits, self-care management and other matters to facilitate timely/informed decision making throughout all phases of the continuum of care.
• Performs other duties as assigned.

Required Qualification

• Certification - Basic Life Support (BLS) - Upon Start
• Licensure - N/A
• Experience - 3 years of progressive experience with care or disease management to include coordinating patient care and population health programs.
• Education - Bachelor's in social work (BSW) or bachelor's in health, human social services, or related field.

Preferred Qualification

• Certification - Basic Life Support (BLS) - Upon Start + Certified Dementia Practitioner (CDP) certification required within one year of hire
• Experience - at least three years of patient care coordination experience; knowledge of commercial insurance, Medicare, and Medicaid; and preferably three or more years of experience in adult care or geriatrics

About Us

We are Inova, Northern Virginia's leading nonprofit healthcare provider. Every day, our 26,000+ team members provide world-class healthcare to the communities we serve. Our people are the reason we're a national leader in healthcare safety, quality and patient experience. And from best-in-class facilities to professional development opportunities, we support them at every step. At Inova, we're constantly striving to be ever better - to shape a more compassionate future for healthcare.

Inova Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, pregnancy (including childbirth, pregnancy-related conditions and lactation), race, religion, sex, sexual orientation, veteran status, genetic information, or any other characteristics protected by law.