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RN Case Manager II - Washington DC
Company: Children's National
Location: Washington, DC
Posted On: 04/17/2024
Minimum Education
Master's Degree in Nursing (Required)
Minimum Work Experience
5 years nursing experienc, with at least three in a pediatric setting. (Required)
Required Licenses and Certifications
Registered Nurse (Required) Current certification in Case Management (Preferred)
Functional Accountabilities
Professional Practice/Research
- Participates in Shared Leadership.
- Contributes to the MAGNET Journey of Children's National.
- Ensures that nursing practice is based on evidence of best practice.
- Accountable for participating in the Nursing Division's Performance Improvement process (division or unit level).
- Participates in community activities.
Patient Resource Services
- Communicate denials, high risk, or changes in level of care using accepted processes to limit financial risk to CNMC and patients' families.
- Navigate internal and external systems to accurately identify or secure payers and link patients to needed services.
Discharge Transitional Plan of Care
- Define discharge and transitional care criteria with the healthcare team to facilitate efficient care transitions.
- Conduct an initial assessment of patient and family to identify potential discharge barriers and needs in accordance with departmental and regulatory requirements.
- Develop and implement a plan of care and make referrals based on a needs assessment and available resources in conjunction with care team members.
- Transition care to external providers and services to achieve quality outcomes for patient and family.
- Provide clinical reviews to third party payers using nationally recognized criteria and validate authorization or denial of services and document appropriately in STAR.
Documentation
- Identify, implement, and evaluate processes to improve customer service, reimbursement and/or hospital performance.
- Participate in the identification of PI issues and take steps to improve unit or CRM processes.
- Promote the development of CRM department and other members of the healthcare team.Document according to departmental policy.
Performance Improvement
- Identify, implement, and evaluate processes to improve customer service, reimbursement and/or hospital performance.
- Participate in the identification of PI issues and take steps to improve unit or CRM processes.
- Promote the development of CRM department and other members of the healthcare team.
Organizational Accountabilities
Organizational Accountabilities (Staff)
Organizational Commitment/Identification
- Anticipate and responds to customer needs; follows up until needs are met
Teamwork/Communication
- Demonstrate collaborative and respectful behavior
- Partner with all team members to achieve goals
- Receptive to others' ideas and opinions
Performance Improvement/Problem-solving
- Contribute to a positive work environment
- Demonstrate flexibility and willingness to change
- Identify opportunities to improve clinical and administrative processes
- Make appropriate decisions, using sound judgment
Cost Management/Financial Responsibility
- Use resources efficiently
- Search for less costly ways of doing things
Safety
- Speak up when team members appear to exhibit unsafe behavior or performance
- Continuously validate and verify information needed for decision making or documentation
- Stop in the face of uncertainty and takes time to resolve the situation
- Demonstrate accurate, clear and timely verbal and written communication
- Actively promote safety for patients, families, visitors and co-workers
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