Inova Health System
Case Management Workflow Lead
Inova Health System, Alexandria, Virginia, us, 22350
The Case Management Workflow Lead supports the development and implementation of Discharge Planners' (DCP) patient care plans and throughout the continuum of care or disease state. Works collaboratively with Discharge Planners, physicians, nurses, and other members of the multidisciplinary healthcare team to appropriate patient management. Provides coordination of services and acts as a liaison between Discharge Planners (DCP), patients, families, and the interdisciplinary healthcare team members. Provides expertise in discharge planning and continuity of care for assigned patients in the acute and post-acute settings by supporting Discharge Planners.
Job ResponsibilitiesServes as a Lead and resource for Discharge Planners (DCP) and the multi-disciplinary team by supporting the Discharge Planners (DCP) with guidance, training, participating in Multi-Disciplinary Rounds (MDRs), and management of patient assignments.Participates in the assessment of patients' clinical and psychosocial needs through review of patient information, personal contact with patients/families and interdisciplinary care team members, assures 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.Assists 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.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.Documents 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.Performs additional duties as assigned.Additional RequirementsBachelors Degree (BSN) in Nursing or Masters Degree (MSW) in Social Work.Minimum of four years acute care case management experience in an acute healthcare environment.Must have demonstrated understanding of DCP for specific disease states.Must have understanding of Social Determinants of Health (SDOH) impact on health.Basic Life Support (BLS) through the American Heart Association (AHA) upon start.Must be an Accredited or Certified Case Manager (ACM or CCM) upon start.Must be a Registered Nurse (RN) or Licensed Social Worker (LSW) and eligible to practice in the Commonwealth of Virginia.
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Job ResponsibilitiesServes as a Lead and resource for Discharge Planners (DCP) and the multi-disciplinary team by supporting the Discharge Planners (DCP) with guidance, training, participating in Multi-Disciplinary Rounds (MDRs), and management of patient assignments.Participates in the assessment of patients' clinical and psychosocial needs through review of patient information, personal contact with patients/families and interdisciplinary care team members, assures 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.Assists 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.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.Documents 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.Performs additional duties as assigned.Additional RequirementsBachelors Degree (BSN) in Nursing or Masters Degree (MSW) in Social Work.Minimum of four years acute care case management experience in an acute healthcare environment.Must have demonstrated understanding of DCP for specific disease states.Must have understanding of Social Determinants of Health (SDOH) impact on health.Basic Life Support (BLS) through the American Heart Association (AHA) upon start.Must be an Accredited or Certified Case Manager (ACM or CCM) upon start.Must be a Registered Nurse (RN) or Licensed Social Worker (LSW) and eligible to practice in the Commonwealth of Virginia.
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