Nurse Lead - Case Management

Location
Washington, District of Columbia
Salary
Competitive
Posted
Sep 30, 2017
Closes
Oct 30, 2017
Contract Type
Permanent
Hours
Full Time
All nursing practice is based on the legal scope of practice, national and specialty nursing standards, CNMC Policies and Procedures, and in accordance with all applicable laws and regulations. The Professional Model of Care requires registered professional nurses to be responsible and accountable for their own practice. CNMC supports the development of RN relationships within the community; specifically those relationships associated with the health and well-being of the community at large. Responsible for daily operations (staffing and assignments) and directing the activities of the Clinical Resource Management department. Provides 24 hour accountability for planning, managing and evaluating department functions. Guides, supervises and elevates the quality of practice for utilization review within Children’s National. Key areas of focus include use of nationally recognized criteria sets, status changes and concurrent denial management.
Qualifications
Minimum Education
Bachelor's Degree

Specific Requirements and Preferences
Master’s degree preferred.

Minimum Work Experience
5 Year(s)

Specific Requirements and Preferences
At least 5 total years of nursing experience. Minimum of one year pediatric experience in a comparable setting. Minimum of 1 year of demonstrated nursing leadership experience.

Required Skills/Knowledge

Familiar with software such as Window’s environment (Microsoft Office, Word, PowerPoint, Excel, Access).
Excellent oral and written communication skills. Fluent in medical management criteria such as MCG and/or InterQual.

Required Licenses and Certifications

Registered Nurse in District of Columbia

Functional Accountabilities

Professional Practice/Research

  • Facilitate the CMI practice group of Shared Nursing Leadership and support other initiatives.

  • Contribute to the sustainability and advancement of Magnet designation.

  • Ensure that utilization review for patient status (IP and Observation) is based on evidence of best practice.

  • Accountable for supporting/participating in the CRM and/or Division of Nursing’s Performance Improvement processes.

  • Participate in community activities.
  • Daily Operations

  • Accountable for staffing and assigning coverage for all roles within CRM; engages with CMI Team Lead, Manager & Director to problem-solve.

  • Responsible for 24/7 assessment and supervision of work flow for CMI’s and support positions.

  • Supervise utilization review activities, interface with internal and external stakeholders to achieve appropriate level of care and optimize reimbursement; ensure compliance with CMS regulations.

  • Interact with payors and CRM leadership to improve the authorization process.

  • Engage in performance improvement activities to standardize and elevate practice.
  • Communication

  • Demonstrate advanced communication skills in dealing with staff and all members of the healthcare team.

  • Provide constructive, sensitive and timely feedback to staff concerning their performance in verbal and written form.

  • Effectively manage conflict and assist others to understand their behavior and their effect on the work environment.

  • Communicate and escalate issues as appropriate to the Manager and Director.
  • Staff Education

  • Facilitate learning opportunities for staff.

  • Participate in the education and training of Case Managers and other staff.
  • 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

  • Organizational Accountabilities (Staff)

    Management and Leadership Skills

  • Monitors Kronos reconciliation and ensures schedule and timecard accuracy

  • Responsible for all aspects of performance appraisal for designated staff

  • Participates in the hiring of staff by completing WFM paperwork, conducting interviews and making recommendations for hire

  • Assumes coverage of unit in absence of Manager & Director and makes decisions within authorized scope

  • Demonstrates initiatives and leadership through involvement in department based projects and committees

  • Establishes collaborative relationships and network across the organization to ensure effective outcomes

  • Represents CRM on organizational committees and initiatives
  • Organizational Commitment/Identification

  • Partner in the mission and upholds the core principles of the organization

  • Committed to diversity and recognizes value of cultural ethnic differences

  • Demonstrate personal and professional integrity

  • Maintain confidentiality at all times
  • Customer Service

  • 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