Experience:
5+ years of experience
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Employment Type:
Full time
Posted:
12/22/2017
Job Category:
Nursing
Industry:
Health Care & Medicine
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Case Manager I (RN only)
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Job Description

Qualifications

 Minimum Education
Bachelor's Degree



Minimum Work Experience
5 Year(s)

Specific Requirements and Preferences
At least 5 years with at least three in clinical nursing. At least one year experience in Utilization Management with knowledge of utilization review criteria. Experience in one or more of the following areas: case management, designated/pediatric specialty


Required Skills/Knowledge




Required Licenses and Certifications




Functional Accountabilities

Professional Practice/Research
  1. Participate in Shared Leadership.
  2. Contribute to the MAGNET Journey of Children’s National.
  3. Ensure that nursing practice is based on evidence of best practice.
  4. Accountable for participating in the Nursing Division’s Performance Improvement process (division or unit level).
  5. Participate in community activities.
Facilitates Efficient & Effective Utilization of Resources for Patients
  1. Conduct timely clinical reviews drawing upon appropriate resources and apply nationally recognized criteria to support medical necessity of patient observation admission or inpatient admission and continued hospitalization.
  2. Address treatment delay, potential and actual denials with the Attending physician and other relevant members of the healthcare team.
Coordinates Authorization for Reimbursement
  1. Provide clinical reviews to third party payers and validates authorization or denial of services from them.
  2. Document approved and denied services in STAR to facilitate meaningful data analysis.
Communicates Effectively
  1. Communicate verbally and/or written e.g., email) with payers and healthcare team in a clear, timely, accurate and professional manner and/or organized in a professional format.
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.