Works with multi-disciplinary team on implementing and evaluating patient care plans and progression throughout the continuum. Works collaboratively in communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely and appropriate patient management. Uses utilization management techniques to determine the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities. Responsible for timely regulatory compliance and facilitation of precertification and payor authorization processes, when indicated. Actively participates in clinical performance improvement activities. Provides discharge planning and continuity of care for assigned patients in the acute and post-acute setting. Understands pre-acute and post-acute resources. Provides coordination of services and acts as key liaison between patient, the patient's family and the interdisciplinary healthcare members.
Required: 1- 2 years in clinical care or clinical case management.
Required: RN licensed, or eligible to practice in the Commonwealth of Virginia as an RN.
Working knowledge of case management processes, needs assessment, principles of utilization review/quality assurance, discharge planning, and reimbursement structures (i.e. Medicare, Medicaid, HMO).
Knowledge of regulatory requirements.
Advanced communication (oral and written) skills to effectively and professionally liaison with patients, families, and medical staff.
Internal Number: 59170BR
About Inova Health System
Inova is a global leader in personalized health, which leverages precision medicine to predict, prevent and treat disease, enabling individuals to live longer, healthier lives. At Inova, we serve more than two million people each year from throughout the Washington, DC, metro area and beyond. Inova's mission is to improve the health of the diverse community it serves through excellence in patient care, education and research. At Inova, more than 16,000 employees demonstrate their commitment every day to providing the community with expert, world-class, compassionate patient care.