Inova

Nonprofit health system operating hospitals

Case Management Program Manager

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours

Full-timeFalls Church, VA, USAIn-person

About the Job

Requirements

Must hold a Master’s degree in Social Work or be a Registered Nurse in Virginia.
Must hold a Bachelor of Science in Nursing or a Master of Social Work degree.
Must have five years of acute care case management experience in an acute healthcare environment.
Must have Basic Life Support certification upon start.
Must hold either Accredited Case Manager or Certified Case Manager certification upon start.

Responsibilities

Serve as a resource for discharge planners and the multidisciplinary team through guidance, training, consultation, participation in Multidisciplinary Rounds, and management of assigned patients.
Ensure continuity of care by reviewing patient assessments and information, arranging appropriate referrals for patient and family Social Determinants of Health needs, and identifying at-risk populations using approved screening tools and established reporting procedures.
Initiate and facilitate referrals to specialists, clinics, home healthcare, hospice, skilled nursing facilities, acute rehabilitation, long-term acute care, transitional care management, and medical equipment and supplies as indicated.
Communicate with patients, families, interdisciplinary healthcare team members, and other appropriate parties about care-plan status, progress toward treatment goals, concerns, problem solving, and conflict resolution; address system problems that impede diagnostic or treatment progress and document as needed for continuity of care.
Consult appropriate disciplines and departments as required to expedite care and facilitate discharge.
Communicate with payers or required parties to ensure reimbursement certification for assigned patients, discuss payer criteria with discharge planners and clinical staff, and follow up to resolve payer problems.
Work with discharge planners and patients’ healthcare teams to manage and coordinate care, and collaborate with discharge planners, interdisciplinary care teams, patients, families, and internal and external case managers on assessment and discharge planning needs.
Provide safe patient care in accordance with policies, procedures, standards, and budget specifications, including time and supply management, productivity, and practice accuracy.
Collect and report resource and financial indicators, including clinical metrics, case mix, length of stay, cost per case, excess days, resource utilization, readmission rates, denials, and appeals.
Serve on agency committees, work groups, and other bodies.
Ensure quality assurance in unit service delivery, including clinical care and documentation; collect, analyze, and address variances from care plans and care paths with physicians and other healthcare team members, and collect delay and other data and quality metrics for performance and outcome indicators.
Perform additional duties as assigned.

Desired Qualifications

Five or more years of inpatient hospital case management experience, including case management discharge planning.
Supervisory or lead experience.
Experience working through medically complex cases.

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.

Salary Range: $100443.00 - $163717.00

Pay Rate Frequency: ANNUAL

About the Company

Inova

Nonprofit health system operating hospitals

Inova Health System is a nonprofit healthcare network based in Falls Church, Virginia, providing a broad range of medical services across hospitals, outpatient clinics, assisted living, and long-term care facilities in Northern Virginia and the Washington, D.C. metro area. Its hospitals have Magnet status, indicating high nursing quality, and the system emphasizes care delivery as well as medical research and education through clinicians and scientists. The organization’s operations rely on reinvesting earnings into its mission rather than distributing profits to shareholders, with the Inova Health Foundation supporting fundraising and philanthropy to expand services, research, and training. Overall, Inova aims to improve community health by delivering patient care, advancing medical knowledge, and educating the next generation of healthcare professionals.

Company size: Not listed
Company stage: Not listed
Total funding: $422.8M
Headquarters: Falls Church, VA
Founded: 1956

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