RN Case Manager II

Minimum Education

Master's Degree In a related field. (Required) Minimum Work Experience 5 years 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 Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance