Registered Nurse (RN) Case Manager

Inova Health; Leesburg (VA); On-site; USD 90,000 - 110,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Retirement matching (5%)

Education assistance up to $5,250/year

Student loan assistance up to $10,000

Mental health support sessions

Paid time off and parental leave

Job summary

Inova Loudoun Hospital is seeking a dedicated Registered Nurse Case Manager 1 to join the Case Management Team as a full-time role, Monday through Friday with rotating weekends. The RN Case Manager will provide discharge planning and continuity of care for patients in acute and post-acute settings, coordinating services and liaising with patients, families, and the care team.

The incumbent will apply utilization management to determine medical necessity and efficiency, and participate in

Responsibilities

• Discharge planning and continuity of care for assigned patients in acute and post-acute settings.
• Coordinate services and act as liaison between patients, families and interdisciplinary healthcare team.
• Ensure medical necessity and appropriate use of services through utilization management techniques.
• Collaborate with healthcare team to manage discharge planning needs and post-discharge services.
• Educate patients and families, addressing social or financial needs and advocating for care progression.

Skills

Case Management

Nursing

Discharge Planning

Interdisciplinary Collaboration

Utilization Management

Job description

Inova Loudoun Hospital is looking for a dedicated Registered Nurse Case Manager 1 to join the Case Management 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

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 outpatient p