Nurse Case Manager Lead

19 hours ago

Oxon Hill, Maryland, United States Inova Health System Full time
Job Title: Case Management Workflow Lead

Inova Health System is seeking a skilled Registered Nurse (RN) to fill the role of Case Management Workflow Lead. This position plays a crucial role in supporting the development and implementation of patient care plans, ensuring seamless coordination of care throughout the continuum of care or disease state.

Key Responsibilities:
  • Collaborate with Discharge Planners, physicians, nurses, and other healthcare team members to ensure appropriate patient management.
  • Provide coordination of services and act as a liaison between Discharge Planners, patients, families, and the interdisciplinary healthcare team.
  • Support Discharge Planners in discharge planning and continuity of care for assigned patients in acute and post-acute settings.
  • Participate in the assessment of patients' clinical and psychosocial needs through review of patient information, personal contact with patients/families, and interdisciplinary care team members.
  • Initiate and facilitate referrals to specialists, clinics, home healthcare, hospice, SNF, acute rehab, LTAC, TCM, medical equipment, and supplies as indicated.
  • Communicate routinely with patients, families, interdisciplinary healthcare team members, and other appropriate parties regarding patient care plans, progress toward treatment goals, identification of concerns/problems, problem-solving, and conflict resolution.
  • Seek consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge.
  • Communicate with payers or required parties to ensure reimbursement certification for assigned patients and discuss payer criteria with the Discharge Planner and issues on a case-by-case basis with clinical staff and follow up to resolve problems with payers as needed.
  • Work closely with Discharge Planners, members of patients' healthcare teams to manage and coordinate all areas of care and collaborate with the DCP, interdisciplinary care teams, patients, and families in the assessment and coordination of discharge planning needs.
  • Ensure safe care to patients by adhering to policies, procedures, and standards, within budgetary specifications including time/supply management, productivity, and accuracy of practice.
  • Assist in the collection and reporting of resource and financial indicators including clinical metrics, case mix, LOS, 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/or other members of the healthcare team, and collect delay and other data, as well as quality metrics, for specific performance and/or outcome indicators.
  • Document key clinical path variances and outcomes which relate to areas of direct responsibility, uses pathway data in collaboration with other disciplines to ensure effective patient management concurrently.
Requirements:
  • Bachelor's Degree (BSN) in Nursing or Master's Degree (MSW) in Social Work.
  • Minimum of four years acute care case management experience in an acute healthcare environment.
  • Must have understanding of Social Determinants of Health (SDOH) impact on health.

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