Children's National Hospital
Case Manager Hybrid I/II
Children's National Hospital, Washington, District of Columbia, us, 20022
Pay Range
Base pay: $75,545.60/yr - $125,923.20/yr (Children's National Hospital range). Your actual pay will be based on your skills and experience – talk with your recruiter to learn more.
Responsibilities
Professional Practice/Research
Participate 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 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 ST AR.
Documentation
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 (Staff)
Anticipate and respond to customer needs; follow up until needs are met.
Demonstrate collaborative and respectful behavior.
Partner with all team members to achieve goals.
Receptive to others’ ideas and opinions.
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.
Use resources efficiently.
Search for less costly ways of doing things.
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 take 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.
Qualifications
Minimum Education
Bachelor’s Degree (Required)
Master’s Degree (Preferred)
Minimum Work Experience
5 years experience with at least three in a pediatric setting (Required)
Required Licenses And Certifications
Registered Nurse in District of Columbia (Required)
Functional Accountabilities
Current certification in Case Management or Utilization Management (Preferred)
Additional Information Primary Location:
District of Columbia-Washington Work Location:
Remote Work Location Job:
Nursing Organization:
Patient Services Position Status:
R (Regular) Shift:
Day Work Schedule:
8a-5:30p Job Posting Date:
Nov 7, 2025 Full-Time Salary Range:
$75,545.60
#J-18808-Ljbffr
Responsibilities
Professional Practice/Research
Participate 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 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 ST AR.
Documentation
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 (Staff)
Anticipate and respond to customer needs; follow up until needs are met.
Demonstrate collaborative and respectful behavior.
Partner with all team members to achieve goals.
Receptive to others’ ideas and opinions.
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.
Use resources efficiently.
Search for less costly ways of doing things.
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 take 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.
Qualifications
Minimum Education
Bachelor’s Degree (Required)
Master’s Degree (Preferred)
Minimum Work Experience
5 years experience with at least three in a pediatric setting (Required)
Required Licenses And Certifications
Registered Nurse in District of Columbia (Required)
Functional Accountabilities
Current certification in Case Management or Utilization Management (Preferred)
Additional Information Primary Location:
District of Columbia-Washington Work Location:
Remote Work Location Job:
Nursing Organization:
Patient Services Position Status:
R (Regular) Shift:
Day Work Schedule:
8a-5:30p Job Posting Date:
Nov 7, 2025 Full-Time Salary Range:
$75,545.60
#J-18808-Ljbffr