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8110 Gatehouse Road, Falls Church, VA 22042

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RN Case Manager PRN

Fairfax Medical Campus 619919 Part Time 3300 Gallows Road, Falls Church, VA, 22042, US

Job Description

As a Registered Nurse (RN) Case Manager – Pro re nata (PRN), you will actively participate in clinical performance improvement activities and provide discharge planning and continuity of care for assigned patients in the acute and post-acute setting. To help achieve our mission, you will understand pre/post-acute resources while providing coordination of services and acting as a key Liaison between patients, families and interdisciplinary healthcare members. Your utilization of management techniques to determine the medical necessity, appropriateness and efficiency of the use of healthcare services, procedures and facilities is of vital importance. Taking ownership for the timely regulatory compliance and facilitation of precertification and payer authorization processes, when indicated, is essential. Working with the multidisciplinary team on implementing and evaluating patient care plans and progression throughout the continuum of care is required. Collaborating with physicians, nurses and other members of the multidisciplinary care team to effect timely and appropriate patient management is expected.

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/supply management, productivity and accuracy of practice. Promotes individual professional growth and development by meeting requirements for mandatory continuing education and skill competencies. 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 settings. Initiates and facilitates referrals to clinics, home healthcare, hospice, SNF, acute rehab, LTAC, TCM, medical equipment and supplies as indicated. Collaborates with interdisciplinary care teams, patients and families in the assessment and coordination of discharge planning needs, delivery of post-discharge planning needs/services and transition of patients from hospitals to discharge settings in addition to ongoing care in the community. Documents relevant discharge planning information in the medical record according to department standards and/or care management plans.
  • Collaborates/communicates with internal and external Case Managers. Understands pre/post-acute resources. Provides coordination of services and acts as a key Liaison between patients, families and the interdisciplinary healthcare team members. Works closely with the members of patients' healthcare teams to manage and coordinate all areas of patient care. Works holistically to ensure that care plans and discharge plans meet the physical, social and emotional needs of patients.
  • Provides educational resources and/or referrals to patients/families to address identified needs such as social or financial needs. 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 the 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 patient clinical and psychosocial needs through review of patient information, personal contact with patients/families and interdisciplinary care team members. Communicates routinely with patients, families, interdisciplinary care team members and other appropriate parties with regard to the status of patient care plans, progress toward treatment goals, identification of concerns/problems, problem solving and assisting with conflict resolution when necessary.
  • Works with multidisciplinary teams 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 patients/families, members of the healthcare team and are documented as necessary to ensure continuity of care.

Additional Requirements