Experience:
5+ years of experience
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Employment Type:
Full time
Posted:
9/14/2017
Job Category:
Nursing
Industry:
Health Care & Medicine
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Case Manager Hybrid I/II (RN)
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Job Description

Qualifications

 Minimum Education
Bachelor's Degree

Specific Requirements and Preferences
Master’s Degree preferred.

Minimum Work Experience
5 Year(s)

Specific Requirements and Preferences
At least 5 years of experience with at least three in a pediatric setting. Extensive clinical experience in Case Management and/or Utilization Management, preferred. Experience in one or more of the following areas: designated/pediatric specialty, program/project development, clinical pathways, and leadership.


Required Skills/Knowledge

Human relations skills critical. Must be proficient with Microsoft office software programs and have keyboard skills.



Required Licenses and Certifications

Registered Nurse in District of Columbia


Current certification in specialty area.
Specific Requirements and Preferences
Current certification in Case Management or Utilization Management, preferred.


Functional Accountabilities

Professional Practice/Research
  1. Participate in Shared Leadership.
  2. Contribute to the MAGNET Journey of Children’s National.
  3. Ensure nursing practice is based on evidence of best practice.
  4. Accountable to participate in the Nursing Division’s Performance Improvement process (division or unit level).
  5. Participate in community activities.
Patient Resource Services
  1. Communicate denials, high risk, or changes in level of care using accepted processes to limit financial risk to CNMC and patients’ families.
  2. Navigate internal and external systems to accurately identify or secure payers and link patients to needed services.
Discharge Transitional Plan of Care
  1. Define discharge and transitional care criteria with the healthcare team to facilitate efficient care transitions.
  2. Conduct an initial assessment of patient and family to identify potential discharge barriers and needs in accordance with departmental and regulatory requirements.
  3. Develop and implement a plan of care and make referrals based on a needs assessment and available resources in conjunction with care team members.
  4. Transition care to external providers and services to achieve quality outcomes for patient and family.
  5. Provide clinical reviews to third party payers using nationally recognized criteria and validate authorization or denial of services and document appropriately in STAR.
Documentation
  1. Document according to departmental policy.
Performance Improvement
  1. Identify, implement, and evaluate processes to improve customer service, reimbursement and/or hospital performance.
  2. Participate in the identification of PI issues and take steps to improve unit or CRM processes.
  3. Promote the development of CRM department and other members of the healthcare team.

Organizational Accountabilities (Staff)

Organizational Commitment/Identification
  1. Partner in the mission and upholds the core principles of the organization
  2. Committed to diversity and recognizes value of cultural ethnic differences
  3. Demonstrate personal and professional integrity
  4. Maintain confidentiality at all times
Customer Service
  1. Anticipate and responds to customer needs; follows up until needs are met
Teamwork/Communication
  1. Demonstrate collaborative and respectful behavior
  2. Partner with all team members to achieve goals
  3. Receptive to others’ ideas and opinions
Performance Improvement/Problem-solving
  1. Contribute to a positive work environment
  2. Demonstrate flexibility and willingness to change
  3. Identify opportunities to improve clinical and administrative processes
  4. Make appropriate decisions, using sound judgment
Cost Management/Financial Responsibility
  1. Use resources efficiently
  2. Search for less costly ways of doing things
Safety
  1. Speak up when team members appear to exhibit unsafe behavior or performance
  2. Continuously validate and verify information needed for decision making or documentation
  3. Stop in the face of uncertainty and takes time to resolve the situation
  4. Demonstrate accurate, clear and timely verbal and written communication
  5. Actively promote safety for patients, families, visitors and co-workers
  6. Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance
 

About Children's National Health System

Childrens National Medical Center is the only exclusive provider of pediatric care in the metropolitan Washington area and is the only freestanding childrens hospital between Philadelphia, Pittsburgh, Norfolk, and Atlanta. Serving the nations children for more than 130 years, Childrens National is a proven leader in the development and application of innovative new treatments for childhood illness and injury.

Childrens National is proudly ranked consistently among the best pediatric hospitals in America by US News & World Report.

Our Culture

Children's mission is to be preeminent in providing pediatric health care services that enhance the health and well-being of children regionally, nationally and internationally. Through leadership and innovation, Children's creates solutions to pediatric healthcare problems. Children's excels in Care, Advocacy, Research, and Education to meet the unique needs of children, adolescents and their families. Children's leadership realizes that our employees are the heart of our medical center and the soul of our mission. One of our greatest assets is the diversity of our workforce, which adds to the richness of our culture. Teamwork, dedication, and professionalism are essential values and characteristics that make our employees unique.

Childrens internationally recognized team of pediatric healthcare professionals care for more than 360,000 patients each year who come from throughout the region, nation and world. Our employees share a sense of pride and commitment to the patients and families we serve. We aspire to provide patients and their families with the highest quality of care and service in a family-centered environment. In essence, we are a team of "Great People Providing Great Care."

Nursing Students

As a nursing student, you might already be craving hands-on experience at a highly respected hospital. You may be thinking about where or with which population you want to work after graduation.

At Childrens, a world-class teaching hospital and internationally-recognized leader in pediatric health, we invite nursing students at all stages of learning to explore the real world of working in a hospital setting and experience first-hand the challenges and rewards of this career.

Internship Program

The internship program provides the novice nurse with the knowledge base and skill set needed to transition to competence in clinical nursing practice. While providing the needed skills to meet the organization goals and mission, the program provides nurses with the leadership skills to work collaboratively within a multidisciplinary team. The program bridges the gap between undergraduate education and real-life professional nursing practice, delivering state-of-the art pediatric care.

The program is offered to new graduate nurses from an accredited nursing program with a passion for children. All new graduates, with less than one-year acute care experience, are eligible to participate in the program after obtaining licensure.