Case Management Program Manager (Registered Nurse OR Social Worker)

Experienced Case Management Program Manager

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 every 3rd weekend rotation and holiday rotation schedule. This position has hybrid capabilities.

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.

Inova Fairfax Hospital is proud to announce that the American Nurses Credentialing Center (ANCC) awarded Magnet® designation, the most prestigious accolade for nursing excellence, to our hospital in December 2020. Currently, only 8.5% of hospitals in the nation hold Magnet® designation and Inova Fairfax Hospital is proud to be part of this select group. The new Magnet designation is in addition to several other prestigious recognitions which include: a five star rating from the Centers for Medicare and Medicaid Services (CMS), being named by IBM Watson Health as one the nation's highest performing hospitals, and among the top 10 Major Teaching Hospitals, an A for Patient Safety by The Leapfrog Group, the #1 hospital in the DC metro area by U.S. News & World Reports, and being nationally ranked in gynecologic care.

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.

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, and flexible work schedules

Case Management Program Manager 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 Requirements:

• Education: Requires a Bachelor's Degree in Nursing or Master's Degree in Social Work.
• Experience : Requires a minimum of five (5) years acute care case management experience in an acute healthcare environment. Demonstrated understanding of DCP for specific disease states. Understanding of Social Determinants of Health (SDOH) impact on health.
• License: Must be licensed in the Commonwealth of Virginia to practice as a Registered Nurse (RN)
• Certification: Basic Life Support (BLS) for Healthcare Provider certification from the American Heart Association required upon start. Must have one of the following: Accredited Case Manager (ACM) or Certified Case Manager (CCM) upon start.

Preferred Qualifications: Note: the qualifications listed below are preferred qualifications in addition to the minimum requirements listed above.

• 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.