RN Case Manager

Children's National Hospital; Washington (District of Columbia); Hybrid; USD 65,000 - 95,000; Full time

Job summary

Children's National Hospital is seeking a Case Manager Hybrid I/II to deliver comprehensive case management services for patients and their families. This role involves assessments, care planning, community outreach, and maintaining high nursing standards. The ideal candidate will have significant experience in pediatric nursing and a strong commitment to community health.

Qualifications

• Bachelor's Degree required; Master's preferred.
• 5 years of experience, 3 in pediatric settings required.
• Registered Nurse in District of Columbia required.

Responsibilities

• Provide case management services to patients and families.
• Assist with assessments and coordinate interventions.
• Engage in outreach activities within the community.

Skills

Case Management

Patient Assessment

Outreach Activities

Team Collaboration

Education

Bachelor's Degree

Master's Degree

Job description

The Case Manager Hybrid I/II will provide case management services to patients and their families or caregivers. Assist with assessment, participate in planning and implementation of intervention, and ensure follow-up and coordination of services. Engage in outreach activities in the community. Assist with administrative tasks as needed. All nursing practice is based on the legal scope of practice, national and specialty nursing standards, Children's National Policies and Procedures, and complies with all applicable laws and regulations. The Professional Model of Care requires registered professional nurses to be responsible and accountable for their own practice. Children's National supports the development of RN relationships within the community, particularly those related to community health and well-being.

Minimum Education
Bachelor's Degree (Required)
Master's Degree (Preferred)

Minimum Work Experience
5 years experience, with at least three in a pediatric setting (Required)

Required Licenses and Certifications
Registered Nurse in District of Columbia (Required)
Current certification in Case Management or Utilization Management (Preferred)

Functional Accountabilities

Professional Practice/Research

• Participate in Shared Leadership.
• Contribute to the MAGNET Journey of Children’s National.
• Ensure nursing practice is based on evidence of best practice.
• Participate in the Nursing Division’s Performance Improvement process at division or unit level.
• Participate in community activities.

Patient Resource Services

• Communicate denials, high risk, or changes in level of care to limit financial risk to CNMC and patients’ families.
• Navigate internal and external systems to identify or secure payers and connect patients to needed services.

Discharge Transitional Plan of Care

• Define discharge and transitional care criteria with the healthcare team for efficient care transitions.
• Conduct initial assessments to identify potential discharge barriers and needs.
• Develop and implement a plan of care, making referrals based on needs assessment and resources.
• Transition care to external providers to achieve quality outcomes.
• Provide clinical reviews to third-party payers using recognized criteria, and validate service authorizations or denials.

Documentation

• Document according to departmental policy.

Performance Improvement

• Identify, implement, and evaluate processes to enhance customer service, reimbursement, and hospital performance.
• Participate in PI issue identification and process improvements.
• Support the development of the CRM department and healthcare team members.

Organizational Accountabilities

Commitment/Identification

• Anticipate and respond to customer needs; follow up until needs are met.

Teamwork/Communication

• Demonstrate collaborative and respectful behavior.
• Partner with team members to achieve goals.
• Be receptive to others’ ideas and opinions.

Performance Improvement/Problem-solving

• Contribute to a positive work environment.
• Show flexibility and willingness to change.
• Identify opportunities for process improvements.
• Make sound decisions using judgment.

Cost Management/Financial Responsibility

• Use resources efficiently.
• Seek less costly methods.

Safety

• Speak up about unsafe behaviors or performance.
• Verify information needed for decisions and documentation.
• Pause to resolve uncertainties.
• Communicate clearly and timely.
• Promote safety for all.
• Attend to details, practicing Stop, Think, Act, Review.