What are the responsibilities and job description for the Registered Nurse (RN) Case Manager I position at Inova?
Registered Nurse (RN) Case Manager I
Full Time with Rotating weekends
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.
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.
Requirements
Education:
BSN or graduate of an accredited school of nursing; either BSN or AD
If RN has an AD, within 6 months of start date the RN must meet with their nurse leader and * Identify which Accredited School the employee plans to attend * Submit a review of transcript from the school indicating the required pre-requisites and timeline for taking the courses * Provide a written plan with anticipated BSN completion date.
Must complete BSN within 24 months of start date.
Experience:
1 year of case management or clinical experience
License:
Active RN license in VA
Certification:
BLS through the American Heart Association
What We Have to Offer YOU!
Benefits and Perks!
Tuition Assistance: Tuition reimbursement up to a maximum assistance of $5,250
Student Loan Assistance: Monthly payment toward team member’s outstanding student loan debt
Paid Parental Leave: Provide up to four weeks 100% pay for team members to care for and bond with a newborn or newly adopted child
Competitive salary
Medical, Dental, Vision & Savings and Spending Accounts (HSA/FSA)
Life Insurance, Short/Long Term Disability
Retirement Savings Plan: Inova makes a matching contribution on the first 5% of pay you contribute
Time Away Programs: You earn or “accrue” PTO on an hourly basis during the calendar year, beginning with your first hour of work.
Supplemental Benefits: Auto/Home Insurance discounts, Pet Insurance & Pet Care Discount Program, Identity Theft Protection, Legal Services
Additional Benefits, Perks, & Discounts: Commuter Benefits, Back-up Child and Elder Care, Adoption Assistance Plan, Credit Union, Team Member Purchasing Program
