Case Management Specialist

Job Description

The Case Management Specialist coordinates and performs administrative activities to support the Case Management department. Participates in the annual and ongoing budget processes, arranges services for assigned patient populations including Home Health, Durable Medical Equipment, Ambulance, Housing, Skilled Nursing Facility and others in order to ensure that appropriate continuing care services are in place for patient transitions. Communicates and documents accurate clinical/financial information in both verbal and written forms in order to assist Case Managers and/or Social Workers in appropriate assessments, implementations and evaluations of patients' continuing care needs. Delivers and documents delivery of regulatory forms such as the mandated Observation letter, and the Medicare IMM notifications. Receives and documents benefit and contract level requirements in order to ensure the appropriate utilization of benefits and services.

Job Responsibilities

• Conducts timely arrangements of services to meet customer requirements.
• Addresses and solves provider and payor issues quickly with support from Case Management staff and performs other duties as assigned.
• Distributes and documents delivery of mandated Observation and Medicare IMM/HINN letters as directed.
• Communicates financial and clinical information to clinicians, patients, families, care team members and external customers.
• Documents clinical and financial patient information in order to assist with discharge, planning and access to continuing care services.
• Communicates with payor and documents detailed instructions on billing, authorization and utilization of services.
• Completes state and federal forms related to patient level of care, according to regulatory standards, in order to assist with patient transition.
• Manages and maintains state required UAI filings as well as all accounts receivable/payable functions for the department to ensure timely payments.
• Maintains and monitors the system Case Management program including reimbursement of all negotiated vendor contracts.
• Provides support to the strategic planning and business development initiatives of the department. Reviews and approves time/attendance for department staff on a biweekly basis. Performs periodic reviews to track employee time and attendance for department leadership. Submits any identified time/pay adjustments to Payroll in a timely manner.
• Maintains records of all system Case Management files and acts as liaison to Foundation, auxiliary and external vendors.
• Assists in monitoring the operational budget, in collaboration with department Director, related to funds disbursement and reconciliation.
• Tracks and monitors accounting for budgets, capital requests, travel funds and business expenses.
• Performs additional duties as assigned.

Additional Requirements

Certification - N/ALicensure - N/AExperience - 2 years of relevant experienceEducation - High School or GED

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. And from best-in-class facilities to professional development opportunities, we support them at every step. At Inova, we're constantly striving to be ever better - to shape a more compassionate future for healthcare.


Inova Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, pregnancy (including childbirth, pregnancy-related conditions and lactation), race, religion, sex, sexual orientation, veteran status, genetic information, or any other characteristics protected by law.