Case Manager II

Kids Are Our Everything.Department10296 Hospital - Integrated Care ManPay Range$87,172.80 - $145,267.20Schedule: Monday-Friday 8:30a-5p; some holiday and weekendsWho We Are:Case Managers work within all areas of Children’s National including Inpatient Units, Psychiatry, PACU, ED, Children's Health Center, Admissions, and Business Operations. Children's Clinical Resource Management/Case Management program is recognized as a national best practice leader in care coordination and financial stewardship. Case Managers are the experts at finding resources and care to meet our patients' needs across the healthcare continuum while ensuring optimal reimbursement so we can all thrive on giving children the best chance at a bright future.What You’ll Do:As a member of our case management team, you will make a meaningful impact in the lives of patients and families every day! As a Case Manager II, you will play a vital role in delivering comprehensive, compassionate care by supporting patients and their families or caregivers throughout their healthcare journey.In this role, you will provide professional case management services that focus on assessing individual needs, contributing to care planning, and implementing targeted interventions designed to improve outcomes. You will work collaboratively with multidisciplinary teams to ensure seamless coordination of services, while also maintaining a strong focus on follow-up care to support continuity and long-term success.Beyond direct patient support, you will extend your impact into the community by engaging in outreach activities that connect families to essential resources and services. Your ability to build relationships, advocate for patient needs, and navigate complex care environments will be critical to ensuring each patient receives the highest level of support.At Children’s National, you’ll be part of an organization committed to excellence, innovation, and compassionate care.What You'll Need:Minimum EducationMaster’s Degree (Required)Minimum Work ExperienceFive (5) years’ experience with at least three (3) years in an acute inpatient setting (Required)Previous experience in one or more of the following areas: case management, designated/pediatric specialty, program/project development, utilization management, clinical pathways, and leadership, preferred. (Preferred)Required Licenses and CertificationsRegistered Nurse license in DC (Required)Current certification in Case Management or Utilization Management (Preferred)Functional AccountabilitiesProfessional Practice/ResearchParticipate in Shared Leadership.Contribute to the MAGNET Journey of Children’s National.Ensure nursing practice is based on evidence of best practice.Accountable to participate in the Nursing Division’s Performance Improvement process (division or unit level).Participate in community activities.Patient Resource ServicesCommunicate 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 CareDefine 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.DocumentationIdentify, implement, and evaluate processes to improve customer service, reimbursement and/or hospital performanceParticipate 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 ImprovementIdentify, implement, and evaluate processes to improve customer service, reimbursement and/or hospital performance.Participate in the identification of Process Improvement issues and take steps to improve unit or CRM processes.Promote the development of CRM department and other members of the healthcare team.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.The disclosed salary range includes the minimum and maximum rates within which Children’s National believes an individual’s base pay rate will fall for this position. It is not typical for an individual to be hired at or near the maximum of the pay range. The exact pay rate for this position will be based on a variety of factors in alignment with the Children’s National compensation philosophy. These factors are legitimate and non-discriminatory including, but not limited to, the current market conditions; organizational needs; the individual’s combination of prior work experience, level of education, knowledge, skills, and other qualifications. Children’s National is committed to providing a fair and competitive total rewards package to each of our employees. This base salary range does not include our comprehensive benefits package or any additional compensation for which this position may be eligible.Childrens National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law. The “Know Your Rights” poster is available here: and the pay transparency policy is available here: Know Your RightsPay Transparency Nondiscrimination Poster.Please note that it is the policy of Children's National Hospital to ensure a “drug-free” work environment: a workplace free from the illegal use, possession or distribution of controlled substances (as defined in the Controlled Substances Act), or the misuse of legal substances, by all staff (management, employees and contractors). Though recreational and medical marijuana are now legal in the District of Columbia, Children's National and its affiliates maintain the right, in accordance with our policy, to enforce a drug-free workplace, including prohibiting recreational or prescribed marijuana. #J-18808-Ljbffr