RN Case Manager II

The Case Manager II will provide case management services to patients and their families or caregivers. Assist with assessment, participate in planning and implementation of intervention and ensure follow-up and coordination of services. Engage in outreach activities in the community. Assist with administrative tasks, as needed. 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.

Qualifications:
Minimum Education
Master's Degree In a related field. (Required)

Minimum Work Experience
5 years experience 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.