Inova

Nonprofit health system operating hospitals

Registered Nurse Case Manager 1 - Emergency Department

Medical, Clinical & VeterinaryPosted on Nov 14

Full-timeLeesburg, VA, USA$86.1k - $140.3k /yrIn-person

About the Job

Requirements

Hold Basic Life Support certification.
Be licensed or eligible for licensure in Virginia as a Registered Nurse, or hold an active multi-state Registered Nurse license.
Have at least 1 year of case management and/or clinical care experience.
Hold a Bachelor's degree in Nursing or an Associate's degree. An RN with an Associate's degree must, within 2 years of hire, identify an accredited school, provide a written plan with an anticipated BSN completion date, submit a transcript review outlining prerequisites and course timing, and complete the BSN within 5 years of the start date.

Responsibilities

Provide discharge planning and continuity of care for assigned patients in acute and post-acute settings.
Coordinate services and serve as a liaison among patients, families, and interdisciplinary healthcare team members.
Use utilization management techniques to determine medical necessity, appropriateness, and efficiency of healthcare services, procedures, and facilities.
Facilitate precertification and payer authorization processes when indicated, ensuring timely regulatory compliance.
Participate in clinical performance improvement activities.
Collect delay and performance or outcome indicator data, and assist in collecting and reporting resource and financial indicators, including case mix, length of stay, cost per case, excess days, resource utilization, readmission rates, denials, and appeals.
Collect, analyze, and address variances from plans of care and care paths with physicians and other healthcare team members; use concurrent variance data to drive practice changes and improve outcomes; document key clinical path variances and outcomes within areas of responsibility.
Use pathway data collaboratively with other disciplines to support effective concurrent patient management.
Provide safe care in accordance with policies, procedures, and standards within budget specifications, including time management, supply management, productivity, and practice accuracy.
Meet mandatory and continuing education and skills competency requirements to support professional growth and development.
Support department-based goals that contribute to organizational success.
Initiate and facilitate referrals to clinics, home healthcare, hospice, skilled nursing facilities, acute rehabilitation, long-term acute care, transitional care management, and medical equipment and supplies as indicated.
Collaborate with the interdisciplinary healthcare team, patients, and families to assess and coordinate discharge needs, deliver post-discharge services, transition patients from hospital to discharge settings, and support ongoing community care.
Document relevant discharge planning information in medical records according to department standards and care management plans.
Collaborate and communicate with internal and external case managers and use knowledge of pre-acute and post-acute resources to coordinate patient services.
Work with patients' healthcare teams to manage and coordinate all areas of care, ensuring healthcare and discharge plans address patients' physical, social, and emotional needs.
Provide educational resources or referrals to patients and families for identified social or financial needs, and advocate for patients to resolve barriers to care progression.
Discuss payer criteria and issues with clinical staff on a case-by-case basis and follow up to resolve payer problems as needed.
Apply approved clinical criteria to monitor the appropriateness of admissions, continued stays, and post-acute settings, and document findings according to department standards.
Identify at-risk populations using approved screening tools and established reporting procedures.
Monitor length of stay and ancillary resource use according to inpatient or outpatient program criteria, take action to improve efficiency, and refer cases or issues appropriately to resolve barriers to care progression.
Assess patients' clinical and psychosocial needs by reviewing patient information and contacting patients, families, and interdisciplinary healthcare team members.
Communicate routinely with patients, families, healthcare team members, and other appropriate parties about care plan status, treatment-goal progress, concerns, problem solving, and conflict resolution.
Work with the multidisciplinary team to resolve system problems that impede diagnostic or treatment progress.
Consult appropriate disciplines or departments to expedite care and facilitate discharge.
Ensure all critical elements of patient care plans are communicated to patients, families, and healthcare team members.
Perform other duties as assigned.

Desired Qualifications

Have one year of previous hospital case management experience, particularly case management discharge planning.
Have emergency department experience.

Inova Loudoun Hospital is looking for a dedicated Registered Nurse Case Manager 1 to join the ED team. This role will be Full Time, Monday - Friday (Occasional holidays), three 12 hour shifts, 7AM - 7.30PM, with varying workdays.

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 Case Manager 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 program criteria, on an ongoing basis and takes actions to achieve continuous improvement efficiencies in both areas. Refers cases and issues appropriately to resolve barriers to care progression.
Participates in the assessment of 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 appropriate parties with regard to the status of patients' care plans and progress toward treatment goals, identification of concerns and/or problems, problem solving and assisting with conflict resolution when necessary. 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 that all elements critical to patients' care plans have been communicated to the patients/families and members of the healthcare team.
Performs other duties as assigned.

Minimum Qualifications:

Certification: Basic Life Support
Licensure: Licensed or eligible for licensure in the Commonwealth of Virginia as a Registered Nurse or an active multi-state Registered Nurse license
Experience: 1 year of case management and/or clinical care experience
Education: Bachelor's Degree Nursing or Associate's Degree. 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: 1.) Identify which accredited school they plan to attend 2.) Provide a written plan with anticipated BSN completion date 3.) Submit a review of transcripts from the school indicating the required pre-requisites and timeline for taking the courses 4.) Complete BSN within 5 years of start date.
Preferred Qualifications:
One year of previous hospital case management experience and case management discharge planning is highly preferred. ED experience is a plus.

Salary Range: $86091.00 - $140338.00

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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