Nurse Manager - Ambulatory Case Management

Location
WASHINGTON, District of Columbia-WASHINGTON
Posted
Oct 08, 2021
Closes
Nov 12, 2021
Ref
210002Y4
Function
Management, Nurse
Industry
Healthcare
Hours
Full Time
Supervise and evaluate the daily work of Case Managers in accordance with departmental and organizational policies. Provide education within the department and the organization at large on clinical care, levels of care, and financial issues. Analyze and report data related to case management activities, payer activities, resource utilization, and clinical denials. Lead hospital wide initiatives on behalf of the department.

Qualifications

Minimum Education
Master's Degree (Required)

Minimum Work Experience
4 years .

Required Skills/Knowledge
Facile with keyboarding and familiar with software such as Windows environment (i.e., Microsoft Office, Word, PowerPoint, Excel, Access).
Excellent oral and written communication skills. Knowledge of children's health issues.
Knowledge of cultural issues and their impact on health care. Strong focus on Service Excellence.
Working experience with medical management criteria such as Milliman and/or Interqual.
Ability to analyze and present productivity and outcome data using Microsoft Access and Excel.

Required Licenses and Certifications
Registered Nurse in District of Columbia .Basic Life Support for Healthcare Provider (BLS) .

Functional Accountabilities
Grow

  • Encourage and share new ways of making the right work easier to do


  • Recognize and share incremental improvements in operations
  • Promote the success of organizational and department initiatives by clearly aligning programs to the mission

Operations Management

  • Supervise and evaluate the daily work of Case Managers in accordance with departmental and organizational policies.


  • Assist with Case Management staffing schedule to ensure adequate coverage and optimize productivity . Assign coverage and deploy staffing accordingly .
  • Function as a resource to staff and takes steps to resolve issues that arise internally and with payors and post acute providers.
  • Work directly with payors to enhance communication and improve authorization processes.
  • Assist with the management of High Risk cases and tracking.
  • Participates in budget development and recommends budgets for areas of oversight
  • Tracks spending for areas of oversight

Education

  • Provide education to the department and the organization related to payor trends, denial activity, observation status, and utilization/case management outcomes.


  • Provide input and oversight to Shared Nursing Leadership's educational activities.

Relationship Building/Information Sharing

  • Establish and maintain effective internal and external relationships to optimize achieving departmental and organizational goals.


  • Provide information to Case Managers on organizational initiatives and professional trends in practice.
  • Represent Clinical Resource Management on organizational committees.

Performance Improvement/Outcomes Management

  • Ensure Case Management activites are in regulatory compliance (JC, CMS)


  • Track clinical,functional, operational, quality and financial data related to Clinical Resource Management
  • Implement processes to continually improve performance, reduce denials and optimize reimbursement
  • Update CRM Departmental procedures to reflect changes in payor contracts and departmental processes.


Organizational Accountabilities
Organizational Accountabilities (Leader)
Deliver
  • Set and clearly communicate team goals and priorities in alignment with departmental goals and budgets
  • Develop the budget and assign resources to meet the team goals
  • Provide the resources and guidance required for employees to perform effectively
  • Develop procedures to ensure high safety and quality, and course-correct as needed
  • Identify customers' needs and ensure service excellence in meeting those needs


Engage
  • Be the link between the department and the team in defining the strategies to meet team goals
  • Provide prompt and clear feedback to staff and support their performance
  • Ensure team adherence to organizational regulations
  • Manage the working environment to promote productivity and motivation
  • Represent the team in clearing obstacles to high performance
  • Hire staff and develop their capabilities
  • Monitor and promote strong employee engagement


Grow

  • Encourage and share new ways of making the right work easier to do
  • Recognize and share incremental improvements in operations
  • Promote the success of organizational and department initiatives by clearly aligning programs to the mission


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.

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