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Clinical Resource Management Lead

2 months ago


Washington, United States Children's National Hospital Full time
ABOUT CHILDREN'S NATIONAL HOSPITAL

Children's National Hospital is a leading nonprofit organization dedicated to providing exceptional healthcare services for children and young adults with special health care needs. Our multidisciplinary team, comprising over 750 professionals and numerous volunteers, is committed to enhancing the lives of our patients and their families through innovative and compassionate care.

MISSION AND VALUES

Mission Statement
Children's National Hospital is devoted to delivering and coordinating high-quality, community-focused care for individuals with complex medical needs. We empower our patients and their families to enhance their quality of life.

Core Values
We believe in:
- The strength of a culturally diverse community.
- The importance of inclusivity for individuals, families, and staff to foster positive outcomes.
- Compassionate and empathetic treatment for all.
- The critical role of our skilled and dedicated staff in achieving success.
- The necessity to adapt continually to the evolving needs of our community.
- The significance of promoting independence for individuals and their families.

POSITION OVERVIEW

The Clinical Resource Management Lead is accountable for overseeing the daily operations and leadership of the Collaborative Services team at Children's National Hospital. Reporting to the Director of Integrated Care Management, this role involves ensuring compliance with nursing standards, policies, and regulations while fostering professional relationships within the community.

Key Responsibilities:
  • Directing new patient referral processes, care coordination, and discharge planning.
  • Managing clinical authorizations and addressing inpatient denial issues.
  • Overseeing interdisciplinary management of high-risk patients and ensuring optimal census and throughput.
  • Providing 24-hour accountability for patient admissions and discharges.

Qualifications:
Education:
- Bachelor's Degree in Health Administration, Nursing, Social Work, or a related field (Required).
- Master's Degree in a relevant advanced discipline (Preferred).

Experience:
- Minimum of 5 years in Case Management, including discharge planning and clinical auditing (Required).
- At least 3 years in a supervisory or managerial capacity (Preferred).

Licenses and Certifications:
- Registered Nurse (RN) license (Required).
- Specialty Certification in Case Management (Preferred).

Required Skills:
  • Expertise in admissions processes, utilization review, and care coordination.
  • Thorough understanding of healthcare administration and regulatory compliance.
  • Ability to foster effective relationships with healthcare professionals and stakeholders.
  • Strong analytical skills to assess clinical and financial data.
  • Proficient in utilizing electronic medical records and medical management systems.

Job Functions:
Resource Management:
  • Plan and monitor staffing needs for optimal patient care.
  • Support human resource activities for team members.
  • Lead initiatives for clinical growth and operational efficiency.

Clinical Resource Management:
  • Manage medical necessity denials and implement improvement strategies.
  • Facilitate discussions on high-risk patient management.

Revenue Cycle Management:
  • Identify opportunities for improvement in the revenue cycle.
  • Collaborate with various departments to address payer-specific issues.

Organizational Accountabilities:
  • Demonstrate leadership excellence and commitment to quality service.
  • Foster a collaborative environment that encourages creativity and effective communication.

Working Environment:
This position operates within a hospital setting, requiring the ability to lift and carry light objects. Minimal travel is expected.