Clinical Resource Management Nurse Lead

Clinical Resource Management Nurse Lead

Location: 111 Michigan Avenue Northwest Washington, DC 20010

Kids Are Our Everything.

Pay Range: $92,393.60 - $153,982.40 Schedule: Monday-Friday 8:30-5:00

Who We Are: Children's National's Clinical Resource Management team is a leader in care coordination, utilization management, and financial stewardship. Working across the healthcare continuum, our team partners with patients, families, clinical teams, payers, and community resources to help ensure children receive the right care at the right time and in the right setting. Through thoughtful discharge planning, utilization review, denial prevention and management, and resource coordination, we support safe transitions of care, appropriate use of healthcare resources, and strong clinical and financial outcomes. At the heart of our work is a shared commitment to compassionate, family-centered care and giving every child the best chance for a bright future.

What You'll Do: As the Clinical Resource Management Nurse Lead, you'll provide day-to-day leadership for the Clinical Resource Management department, overseeing staffing, assignments, and daily operations while maintaining 24-hour accountability for planning, managing, and evaluating department functions. You'll guide and supervise utilization review practice across Children's National, helping elevate quality and consistency through the use of nationally recognized criteria sets. Key areas of focus include managing status changes, supporting concurrent denial management, and promoting effective utilization review practices that help ensure appropriate, high-quality care.

What You'll Need: Minimum Education

• Bachelor's Degree (Required)
• Master's Degree (Preferred)

Minimum Work Experience

• Five (5) years' experience (Required)
• One (1) year pediatric experience in a comparable setting (Required)
• One (1) year demonstrated nursing leadership experience (Required)
• Extensive clinical experience in Case Management and/or Utilization Management (Preferred)

Required Skills/Knowledge

• Familiar with software such as Window's environment (Microsoft Office, Word, PowerPoint, Excel, Access).
• Excellent oral and written communication skills.
• Fluent in medical management criteria such as MCG and/or InterQual.

Required Licenses and Certifications

• Registered Nurse license in DC (Required)

Functional Accountabilities Professional Practice/Research

• Facilitate the CMI practice group of Shared Nursing Leadership and support other initiatives.
• Contribute to the sustainability and advancement of Magnet designation.
• Ensure that utilization review for patient status (IP and Observation) is based on evidence of best practice.
• Accountable for supporting/participating in the CRM and/or Division of Nursing's Performance Improvement processes.
• Participate in community activities.

Daily Operations

• Accountable for staffing and assigning coverage for all roles within CRM; engages with CMI Team Lead, Manager & Director to problem solve.
• Responsible for 24/7 assessment and supervision of work flow for CMI's and support positions.
• Supervise utilization review activities, interface with internal and external stakeholders to achieve appropriate level of care and optimize reimbursement; ensure compliance with CMS regulations.
• Interact with payors and CRM leadership to improve the authorization process.
• Engage in performance improvement activities to standardize and elevate practice.

Communication

• Demonstrate advanced communication skills in dealing with staff and all members of the healthcare team.
• Provide constructive, sensitive and timely feedback to staff concerning their performance in verbal and written form.
• Effectively manage conflict and assist others to understand their behavior and their effect on the work environment.
• Communicate and escalate issues as appropriate to the Manager and Director.

Staff Education

• Facilitate learning opportunities for staff.
• Participate in the education and training of Case Managers and other staff.

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

What You'll Receive: Benefits That Support You:

• Comprehensive health coverage, including medical, prescription, infertility, and transgender health services.
• Generous paid time off, including vacation accrual from day one, sick leave, holidays, and a personal day.
• Financial wellness support, including a 401(k) plan and healthcare and dependent care spending accounts.
• Employer-paid life, AD&D, and long-term disability coverage, with optional supplemental plans.
• Additional perks, including tuition assistance, fitness resources, employee assistance, commuter benefits, and more.

Why Join Us:

• Nationally Recognized Excellence Consistently ranked among the Top 10 Children's Hospitals in the nation by U.S. News & World Report.
• Leading Pediatric Care One of the largest and most comprehensive children's hospitals in the country, offering nationally ranked specialties and cutting-edge treatments.
• Innovation & Research A premier academic medical center with a strong commitment to pediatric research, education, and advancing the future of child health.
• Mission-Driven Culture Dedicated to providing family-centered care while fostering a collaborative, supportive environment for clinical teams.