RN Nurse Case Manager II - Inpatient and PACU

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