Case Manager I (RN)

Washington, District of Columbia
Nov 28, 2017
Dec 28, 2017
Case Management
Contract Type
Full Time
All nursing practice is based on the legal scope of practice, national and specialty nursing standards, Children’s National 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. Children’s National supports the development of RN relationships within the community; specifically those relationships associated with the health and well being of the community at large.
Minimum Education

Bachelor's Degree

Minimum Work Experience

5 Year(s)

Specific Requirements and Preferences

At least 5 years with at least three in clinical nursing. At least one year experience in Utilization Management with knowledge of utilization review criteria. Experience in one or more of the following areas: case management, designated/pediatric specialty

Required Skills/Knowledge

Must be proficient with Microsoft office software programs and have keyboard skills.

Required Licenses and Certifications

Registered Nurse in District of Columbia

Licensure & Certification Preferred/Desired: Current certification in Case Management or Utilization Management; current certification in specialty area

Functional Accountabilities

Professional Practice/Research

  • Participate in Shared Leadership.

  • Contribute to the MAGNET Journey of Children’s National.

  • Ensure 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).

  • Participate in community activities.

  • Facilitates Efficient & Effective Utilization of Resources for Patients

  • Conduct timely clinical reviews drawing upon appropriate resources and apply nationally recognized criteria to support medical necessity of patient observation admission or inpatient admission and continued hospitalization.

  • Address treatment delay, potential and actual denials with the Attending physician and other relevant members of the healthcare team.

  • Coordinates Authorization for Reimbursement

  • Provide clinical reviews to third party payers and validates authorization or denial of services from them.

  • Document approved and denied services in STAR to facilitate meaningful data analysis.

  • Communicates Effectively

  • Communicate verbally and/or written e.g., email) with payers and healthcare team in a clear, timely, accurate and professional manner and/or organized in a professional format.

  • 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)

    Engages in Performance Improvement Activities

  • Identify, implement, and evaluate processes to improve customer service, reimbursement, and/or hospital performance.

  • Participate in the identification of PI issues and takes steps to improve utilization review, authorization or CRM processes.

  • Promote the development of CRM department and other members of the healthcare team.

  • 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

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