Director of Case Management

Do you have a passion for healthcare and helping others? Do you enjoy working in a fast-paced, patient-centered environment? Jump-start your career in our Case Management department. Submit your application today!Our Case Management teams are a committed, caring group of colleagues. We have a passion for creating positive patient interactions. If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise!We offer you an excellent total compensation package, including competitive salary, excellent benefit package and growth opportunities. We believe in our team and your ability to do excellent work with us. Your benefits include 401k, PTO medical, dental, flex spending, life, disability, tuition reimbursement, employee discount program, employee stock purchase program and student loan repayment. We would love to talk to you about this fantastic opportunity.Located in the outskirts of Washington, D.C, Reston Hospital Center is a231-bed acute facility,located in the vibrant Town Center of Reston, known for its lively mix of restaurants, shops, and services. We are a HCA (Hospital Corporation of America) facility making it a very secure and reputable facility to work with. HCA is one of the largest healthcare systems throughout the U.S, where healthcare employment opportunities are almost endless!Currently, we hold certifications within ourstroke and total joint centerand is accredited in thechest pain center. Most importantly, we are dedicated to enhancing the health and quality of life in our community by putting patients first.To oversee the management of the patients care from admission to discharge as outlined in the Utilization Review Plan of the hospital. To analyze utilization trends within the hospital. To report the result of utilization review activities to appropriate persons and committees. To ensure processes are in place to assess the need for admission and continued stay: to assess discharge needs and assure these needs are provided in a timely manner. To work with the RSC staff in completing the appeals processes. To work with the RSC staff in tracking denied days. To oversee and manage the department operations of the Case Management Department. To oversee and manage the interdisciplinary plan of care with a focus on evaluating the appropriateness of clinical care, medical necessity, admission status, level of care and resource management. To promote quality outcomes and patient throughput while supporting a balance of optimal care and appropriate resource management. To over the processes that will identify potential barriers to patient throughput and quality outcomes and will ensure appropriate discharge plans.

Oversees and manages the process for admission and continued stay reviews as outlined in UR plan.

Oversees and manages process for reviews using approved criteria to evaluate necessity of admissions and continued stays.

Consults with attending physicians, nursing staff, and discharge planning assistant to ensure timely discharge of patients to home or other level of care.

Performs a monthly analysis of UR activities.

Reports results of UR activities to appropriate persons and committees.

Maintains accurate records of all UR reviews and activities.

Oversee and manages the collection of data for quality improvement purposes.

Complies with Joint Commission and CMS standards for UR.

Is thoroughly familiar with all aspects of UR plan.

Routine review and revision of UR plan.

Stays abreast of latest trends and developments in Case Management.

Ensures process are in place to manage initial and ongoing patient assessment with emphasis on the total needs at discharge.

Ensures processes are in place for referrals to appropriate community agencies and services and provides information to patient about hospital community resources.

Oversees and manages discharge planning processes.

Works with nursing and other clinical departments to establish and coordinate discharge plan.

Ensures processes are in place to refer questionable admissions and continues stays to the VP for Medical Affairs, who serves as the Physician Advisor.

Assist the VP of Medical Affairs in the review process and the adverse determination process.

Communicate to Livanta (QIO) all required admission and continued stay adverse determinations information.

Hospital Corporation of America (HCA) is a leading healthcare provider with over 31.2 million patient encounters a year at locations in 21 states including the UK. We care about our community! HCA has been continually named one of Ethisphere’s most ethical company’s in the world since 2010. In 2018, HCA spent an estimated $3.3 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply. We promptly review all applications. If you are highly qualified you will hear from one of our managers. Come unlock the possibilities and apply today!We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.Education: Graduate of an accredited school of nursing preferred.

Licensure: Current licensure as a Registered Nurse in the Commonwealth of Virginia or other compact state.

Experience: Previous clinical experience in a hospital setting, preferred. Experience in utilization management. Experience in discharge planning. Previous experience with computerized systems preferred. Certification in Case Management preferred. Ability to establish and maintain collaborative and effective working relationships. Ability to communicate effectively in oral, written and electronic formats. Demonstrates analytical and critical thing abilities with pro-active decision-making and negotiation skills.Job: Directors & Managers Title: Director of Case Management Location: Virginia-Reston-Reston Hospital Center - Reston Requisition ID: 08540-18678