RN Ambulatory Case Manager

4 weeks ago

Washington, United States Children's National Full time
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

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