RN Case Manager II

Minimum Education
Master's Degree In a related field. (Required)

Minimum Work Experience
5 years experience 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.