staff nurse - Fairfax, VA, United States - Inova Health System

Description

Inova Health System is seeking a Registered Nurse (RN) Case Management for a nursing job in Fairfax, Virginia.


Specialty:
Case Management


Shift:
days


Employment Type:
Staff

The RN Case Manager 1 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.
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. Provides discharge planning and continuity of care for assigned patients in the acute and postacute 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 postdischarge planning needs, delivery of postdischarge 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.
• 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 followsup to resolve problems with payers as needed. Applies approved clinical criteria to monitor appropriateness of admissions, continued stays or postacute setting appropriateness and documents findings based on department standards.
• Identifies at risk populations by using approved screening tools and following established reporting procedures. 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. 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.
• Bachelor of Science in Nursing (BSN). One year of Case Management and/or clinical care experience.

-