Case Management Specialist

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The Case Management Specialist coordinates and performs administrative activities to support the Case Management department. Participates in the annual and ongoing budget processes, arranges services for assigned patient populations including Home Health, Durable Medical Equipment, Ambulance, Housing, Skilled Nursing Facility and others in order to ensure that appropriate continuing care services are in place for patient transitions. Communicates and documents accurate clinical/financial information in both verbal and written forms in order to assist Case Managers and/or Social Workers in appropriate assessments, implementations and evaluations of patients’ continuing care needs. Delivers and documents delivery of regulatory forms such as the mandated Observation letter, and the Medicare IMM notifications. Receives and documents benefit and contract level requirements in order to ensure the appropriate utilization of benefits and services.

Inova Fairfax Hospital is looking for a dedicated Case Management Specialist to join the team. This role will be Full-Time, Day Shift, Monday – Friday working 8-hour shift (8:00 a.m. – 4:30 p.m.). Some weekends and holidays rotation required.

Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation.

Featured Benefits:

• Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program.
• Retirement: Inova matches the first 5% of eligible contributions – starting on your first day.
• Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans.
• Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost.
• Work/Life Balance: offering paid time off, paid parental leave

Case Management Specialist Job Responsibilities:

The Case Management Specialist coordinates and performs administrative activities to support the Case Management department. Participates in the annual and ongoing budget processes, arranges services for assigned patient populations including Home Health, Durable Medical Equipment, Ambulance, Housing, Skilled Nursing Facility and others in order to ensure that appropriate continuing care services are in place for patient transitions.

• Communicates and documents accurate clinical/financial information in both verbal and written forms in order to assist Case Managers and/or Social Workers in appropriate assessments, implementations and evaluations of patients’ continuing care needs.
• Delivers and documents delivery of regulatory forms such as the mandated Observation letter, and the Medicare IMM notifications. Receives and documents benefit and contract level requirements in order to ensure the appropriate utilization of benefits and services.
• Conducts timely arrangements of services to meet customer requirements.
• Addresses and solves provider and payor issues quickly with support from Case Management staff and performs other duties as assigned.
• Distributes and documents delivery of mandated Observation and Medicare IMM/HINN letters as directed.
• Communicates financial and clinical information to clinicians, patients, families, care team members and external customers.
• Documents clinical and financial patient information in order to assist with discharge, planning and access to continuing care services.
• Communicates with payor and documents detailed instructions on billing, authorization and utilization of services.
• Completes state and federal forms related to patient level of care, according to regulatory standards, in order to assist with patient transition.
• Manages and maintains state required UAI filings as well as all accounts receivable/payable functions for the department to ensure timely payments.
• Maintains and monitors the system Case Management program including reimbursement of all negotiated vendor contracts.
• Provides support to the strategic planning and business development initiatives of the department. Reviews and approves time/attendance for department staff on a biweekly basis. Performs periodic reviews to track employee time and attendance for department leadership. Submits any identified time/pay adjustments to Payroll in a timely manner.
• Maintains records of all system Case Management files and acts as liaison to Foundation, auxiliary and external vendors.
• Assists in monitoring the operational budget, in collaboration with department Director, related to funds disbursement and reconciliation.
• Tracks and monitors accounting for budgets, capital requests, travel funds and business expenses.

Minimum Qualifications:

• Education: High School or GED
• Experience: 2 years of relevant experience

Preferred Qualifications:

• Administrative/clerical experience in healthcare

As a recipient of federal financial assistance, Inova Health System (“Inova”) does not exclude, deny benefits to, or otherwise discriminate against any person on the basis of race, color, national origin, sex, sexual orientation, disability, or age in admission to, participation in, or receipt of the services or benefits under any of its programs or activities, whether carried out by Inova directly or through a contractor or any other entity with which Inova arranges to carry out its programs and activities.
This policy is in accordance with the provisions of Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, Section 1557 of the Affordable Care Act, and regulations of the U.S. Department of Health and Human Services issued pursuant to these statutes at 45 C.F.R. Parts 80, 84, 91 and 92, respectively.

 

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