Inova Health Systems

Case Management Program Manager - Loudoun

Inova Health Systems • $85K — $100K *
Leesburg, VA 20176In-Person
Healthcare
5 - 7 years of experience
Today
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Job Overview by Ladders

Qualifications

  • Master's Degree in Social Work or Registered Nurse in Virginia required
  • 5 years of acute care case management experience
  • Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification required upon start
  • Basic Life Support certification required upon start
  • BSN or MSW preferred

Responsibilities

  • Oversee daily operations of Case Management and implement patient care plans
  • Serve as a resource for discharge planners and multidisciplinary teams
  • Ensure continuity of care and appropriate referrals for patient needs
  • Communicate with patients, families, and healthcare teams regarding care plans
  • Facilitate consultations with appropriate disciplines to expedite care
  • Manage communication with payers for reimbursement certification
  • Collect and report clinical metrics and financial indicators

Benefits

  • Full-time, day shift schedule: Monday - Friday
  • Collaborative work environment with multidisciplinary teams
  • Opportunity to impact patient care and outcomes
  • Engagement in quality assurance and performance improvement initiatives
  • Potential for professional development and training opportunities
Full Job Description
Job Description

Inova Loudoun 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.

The Case Management Program Manager oversees the daily operations of Case Management on the unit, which includes the development and implementation of discharge planners' (DCP) patient care plans throughout the continuum of care or disease state. Works collaboratively with discharge planners, physicians, nurses and other members of the multidisciplinary healthcare team to ensure appropriate patient care management. Provides management of services and acts as a liaison between Discharge Planners (DCP), patients, families and the interdisciplinary healthcare team members. Manages discharge planning and continuity of care for assigned patients in the acute and post-acute settings.

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.


About Inova Health Systems

Inova Health Systems is a non-profit healthcare organization that provides medical services to patients in Virginia and the Washington, D.C. metropolitan area. The organization was founded in 1956 and is headquartered in Falls Church, Virginia. Inova Health Systems operates several hospitals and medical centers, as well as a network of primary care and specialty clinics. The organization is committed to providing high-quality, patient-centered care and is recognized for its expertise in areas such as cancer care, heart and vascular care, and women's health.
Learn more about Inova Health Systems
Size
18,000 employees
Industry
Healthcare
* Ladders Estimates

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