Registered Nurse (RN) Case Manager 2

Inova Fair Oaks Hospital is seeking a dedicated RN Case Manager to join our team.

Benefits

• Medical, dental, and vision coverage
• Robust team member wellness program
• Retirement: Inova matches the first 5% of eligible contributions starting on your first day
• Tuition and student loan assistance: up to $5,250 per year in education assistance and up to $10,000 for student loans
• Mental health support: 25 mental health coaching or therapy sessions per year at no cost for team members, their spouses/partners, and their children
• Paid time off and paid parental leave

Responsibilities

• Develops, implements, and evaluates patient care plans and progression throughout the continuum of care or disease state
• Provides discharge planning and continuity of care for assigned patients in acute and post-acute settings
• Initiates and facilitates referrals to clinics, home healthcare, hospice, skilled nursing facilities (SNF), acute rehab, long-term acute care (LTAC), transitional care management (TCM), medical equipment, and supplies as indicated
• Collaborates with the interdisciplinary healthcare team, patients, and families in assessing and coordinating discharge planning needs, delivering post-discharge services, and transitioning patients from hospitals to discharge settings and ongoing community care
• Documents relevant discharge planning information in medical records according to department standards and/or care management plans
• Collects delay and other data for specific performance and/or outcome indicators
• Assists in collecting and reporting resource and financial indicators including acute and post-acute case mix, length of stay (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 healthcare team members
• Uses concurrent variance data to drive practice changes and positively impact outcomes
• Documents key clinical path variances and outcomes related 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 contributing to the success of the organization
• Works collaboratively with physicians, nurses, and other multidisciplinary team members to effect timely and appropriate patient management
• Collaborates and 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 interdisciplinary healthcare team members
• Works holistically to ensure healthcare and discharge plans meet the physical, social, and emotional needs of patients
• Provides educational resources and/or referrals to patients and 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 healthcare services, procedures, and facilities
• Communicates with payers or required parties to ensure reimbursement certification for assigned patients
• 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 using approved screening tools and follows established reporting procedures
• Monitors LOS and ancillary resource use, depending on inpatient stay or outpatient program criteria, and takes actions to achieve continuous improvement efficiencies
• Refers cases and issues appropriately to resolve barriers to care progression
• Participates in assessing patients' clinical and psychosocial needs through review of patient information, personal contact with patients/families, and interdisciplinary healthcare team members
• Communicates routinely with patients, families, interdisciplinary healthcare team members, and other parties regarding the status of patients' care plans, progress toward treatment goals, identification of concerns/problems, problem-solving, and conflict resolution
• Works with the multidisciplinary team to address/resolve system problems impeding diagnostic or treatment progress
• Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge
• Ensures all critical elements of patients' care plans are communicated to patients/families and members of the healthcare team
• Performs other duties as assigned

Requirements

• Basic Life Support certification
• Accredited Case Manager (ACM), Certified Case Manager (CCM), or Managed Care Nurse (MCG) certification
• Licensed or eligible for licensure in the Commonwealth of Virginia as a Registered Nurse or an active multi-state Registered Nurse license
• 2 years of case management and/or clinical care experience
• Bachelor’s Degree in Nursing or Associate’s Degree in Nursing

If RN has an Associate’s Degree, within 2 years of date of hire, they must meet with their nurse leader and conduct the following:

• Identify which accredited school they plan to attend
• Provide a written plan with anticipated BSN completion date
• Submit a review of transcripts from the school indicating the required pre-requisites and timeline for taking the courses
• Complete BSN within 5 years of start date

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. We support our team members at every step, from best-in-class facilities to professional development opportunities. At Inova, we're constantly striving to shape a more compassionate future for healthcare.