Registered Nurse (RN) Case Manager

Inova Health; Alexandria (VA); On-site; USD 78,000 - 102,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Retirement match

Education assistance

Student loan assistance

Mental health support

Paid time off

Paid parental leave

Job summary

Inova Mt. Vernon Hospital is seeking an Experienced Registered Nurse Case Manager 1 for a full-time role in Alexandria, VA.

The RN Case Manager coordinates discharge planning and continuity of care for patients in acute and post-acute settings, interfacing with patients, families and the health care team to ensure appropriate utilization of services. Responsibilities include coordinating referrals, ensuring regulatory compliance, supporting performance improvement initiatives, and collaborating

Qualifications

• Discharge planning for acute and post-acute settings.
• Coordinate services across the care continuum.
• Use utilization management to determine medical necessity and efficiency.

Responsibilities

• Provide discharge planning and continuity of care for assigned patients in the acute and post-acute setting.
• Initiate and facilitate referrals to clinics, home health, hospice, SNF, and other services as needed.
• Collaborate with the interdisciplinary team to coordinate discharge planning needs and post-discharge care.
• Communicate with internal and external case managers to ensure seamless patient care.
• Provide education and resources to patients and families to address identified needs.
• Discuss payer criteria with clinical staff and resolve issues with payers as needed.
• Identify at-risk populations using approved screening tools and monitor LOS and resource use.

Skills

Discharge planning

Care coordination

Utilization management

Interdisciplinary collaboration

Job description

Inova Mt. Vernon Hospital is looking for a dedicated Experienced Registered Nurse Case Manager 1 to join the team. This role will be Full-Time; Monday - Friday, rotating weekends. 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.

The RN Case Manager 1 provides discharge planning and continuity of care for assigned patients in acute and post-acute settings. Provides coordination of services and acts as key liaison between patients, families and interdisciplinary healthcare members. Uses utilization management techniques to determine the medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and facilities. Responsible for the timely regulatory compliance and facilitation of precertification and payer authorization processes when indicated. Actively participates in clinical performance improvement activities.

Registered Nurse (RN) Case Manager 1 Job Responsibilities:

• Collects delay and other data for specific performance and/or outcome indicators. Assists in the collection and reporting of resource and financial indicators including acute and post-acute case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals. Collects, analyzes and addresses variances from plans of care and care paths with physicians and/or other members of the healthcare team. Uses concurrent variance data to drive practice changes and positively impact outcomes. Documents key clinical path variances and outcomes which relate to areas of direct responsibility (e.g. discharge planning, chronic disease planning).
• Uses pathway data in collaboration with other disciplines to ensure effective patient management concurrently. Ensures safe care to patients by adhering to policies, procedures and standards within budgetary specifications including time management, supply management, productivity and accuracy of practice. Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency. Supports department based goals which contribute to the success of the organization.
• Provides discharge planning and continuity of care for assigned patients in the acute and post-acute setting. Initiates and facilitates referrals to clinics, home healthcare, hospice, SNF, acute rehab, LTAC, TCM, medical equipment and supplies as indicated. Collaborates with the interdisciplinary healthcare team, patients and families in the assessment and coordination of discharge planning needs, delivery of post-discharge planning needs, delivery of post-discharge services and transition of patients from hospitals to the discharge setting as well as ongoing care in the community. Documents relevant discharge planning information in medical records according to department standards and/or care management plans.
• Collaborates/communicates with internal and external case managers. Understands pre-acute and post-acute resources. Provides coordination of services and acts as a key Liaison between patients, families and the interdisciplinary healthcare team members. Work closely with members of patients' healthcare teams to manage and coordinate all areas of patients' care. Works holistically to ensure that healthcare plans and discharge plans meet the physical, social and emotional needs of patients.
• Provides educational resources and/or referrals to patients and patients' families to address identified needs such as social or financial. Acts as an advocate for patients to resolve barriers to care progression. Uses utilization management techniques to determine the medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and facilities.
• Discusses payer criteria and issues on a case by case basis with clinical staff and follows-up to resolve problems with payers as needed. Applies approved clinical criteria to monitor appropriateness of admissions, continued stays or post-acute setting appropriateness and documents findings based on department standards.
• Identifies at risk populations by using approved screening tools and following established reporting procedures. Monitors LOS and ancillary resource use, depending on inpatient stay or