Children's National Medical Center
Nurse Clinical Resource Management Supervisor
Children's National Medical Center, Washington, District of Columbia, us, 20022
Overview
Nurse Clinical Resource Management Supervisor - (240001G1) Clinical Resource Management leads the day-to-day operations of the Collaborative Services team at the Pediatric Center. This position reports to the CN Director of Integrated Care Management with matrix reporting to the Director of Patient Care Services. All nursing practice is based on the legal scope of practice, national and specialty nursing standard Policies and Procedures, and in accordance with applicable laws and regulations. The Professional Model of Care requires registered professional nurses and social workers to be responsible and accountable for their own practice. Supports the development of RN relationships within the community and with health-related community needs. Responsibilities include directing new patient referral intake, authorization and acceptance; patient care coordination, care progression and discharge planning; initial and continued stay clinical authorizations; inpatient denial mitigation and management; interdisciplinary high-risk patient management; census and throughput management; and daily reporting to executive leadership at Children\'s National Hospital and The Pediatric Center. Provides 24-hour accountability for these functions including weekend admissions and discharges. Qualifications
Minimum Education Bachelor\'s Degree in Health Administration, Social Work, Nursing, Business Administration or related discipline (Required) Master\'s Degree MSN, MBA, MSW, MHA or similar advanced degree (Preferred) Minimum Work Experience 5 years Case Management related experience including discharge planning, utilization review, clinical auditing, and financial/clinical data reporting. Nursing experience (Required) 3 years Supervisory or managerial experience (Preferred) Required Licenses and Certifications Registered Nurse (RN) license from the District of Columbia (Required) Specialty Certification - CCM (Preferred) Required Skills/Knowledge Knowledge of admissions processes, utilization review, discharge planning, case management, social work, care coordination and denial prevention and recovery methodologies Knowledge of healthcare administration and finance; knowledge of District and federal regulations and The Joint Commission regulations Knowledge of hospital risk management processes and performance improvement Ability to develop and maintain effective working relationships with physicians, hospital managers and interdisciplinary care team Ability to develop and maintain effective partnerships with referring hospitals, clinicians, programs, and payers Ability to negotiate and execute single case agreements with Managed Care and Revenue Cycle Strong verbal and written communication Ability to analyze clinical, financial and referral data to identify growth opportunities and measure impact Ability to plan and manage the work of others to achieve outcomes Ability to use complex computer applications including EMR, portals, medical management programs, denial reporting programs and referral management tools Working knowledge of Interqual and MCG guidelines Job Functions
Resource Management Plan for staffing 24/7 and continuously monitor and adjust staffing based on department needs Support Director with HR activities for assigned team including selection, performance evaluation input, remediation and training Accountable for staff timecards and schedules in Kronos Manage hiring by interviewing and recommending hires Lead initiatives, projects and committees for clinical growth and margin improvement Establish collaborative relationships and networks to ensure patient outcomes and volumes Update staff with organizational, case management, care coordination and utilization information Collaboratively define staff workflows, workload, priorities and resource allocation Clinical Resource Management Manage and report medical necessity denials to identify trends and action plans Support systems affecting patient throughput, length of stay, utilization management and discharge planning Lead recoveries of medical necessity-related appeals and implement process improvements to minimize denials and avoidable days Identify denial trends and escalation paths Discuss and plan actions around high-risk and long-stay patients to optimize outcomes while mitigating financial impact Revenue Cycle Management Assess revenue cycle phases to identify opportunities for improvement; collaborate to address DNFB, holds, work queues, charge capture and denial mitigation Work with Managed Care, Revenue Cycle and clinical providers on payer-specific issues Identify potential billing compliance issues; assess risk; coordinate with Compliance to resolve issues Work with Federal, State and local authorities on regulatory issues affecting claims submission and adjudication Communicate financial information to support decision making; develop effective communication with staff and patients/families Provide timely feedback to staff on performance; manage conflicts and support a respectful work environment Escalate clinical issues to Director and MUD as appropriate May perform other duties as needed Organizational Accountabilities
Leadership and Management Demonstrates commitment to quality of service and collaborates to achieve excellence Innovates to improve care and operational efficiency Maintains high standards of performance and safety Encourages diverse teams to communicate effectively and think creatively Drives collaboration to achieve goals efficiently Exhibits strong listening and feedback skills Leadership Skills Assumes responsibility for results and manages organizational change Empowers staff to uphold transparency, fairness, respect and excellence Aligns operational objectives with strategic goals Promotes trust and open communication within the team Supervisory Responsibilities Oversees general direction of staff members Protected Health Information Access Level Level IV – Full Access Physical Requirements Light work: lifting up to 25 lbs; frequent lifting up to 10 lbs Travel Requirements Full-time; regular hours with minimal travel Locations
Primary Location: District of Columbia-Washington Work Locations: Rehab and Specialized Care, 1731 Bunker Hill Road NE, Washington 20017 Job: Management Organization: HSC Pediatric Center Position Status: R (Regular) - FT - Full-Time Shift: Day Work Schedule: 8:30am-5:00pm, Monday-Friday; rotate weekend on-call Job Posting: Aug 15, 2025, 6:55:53 PM Full-Time Salary Range: 85,404.80 - 142,334.40 Equal Opportunity Notice: Children\'s National Hospital is an equal opportunity employer. The policy includes disclosures of rights and poster information; pay transparency and nondiscrimination details are available as applicable.
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Nurse Clinical Resource Management Supervisor - (240001G1) Clinical Resource Management leads the day-to-day operations of the Collaborative Services team at the Pediatric Center. This position reports to the CN Director of Integrated Care Management with matrix reporting to the Director of Patient Care Services. All nursing practice is based on the legal scope of practice, national and specialty nursing standard Policies and Procedures, and in accordance with applicable laws and regulations. The Professional Model of Care requires registered professional nurses and social workers to be responsible and accountable for their own practice. Supports the development of RN relationships within the community and with health-related community needs. Responsibilities include directing new patient referral intake, authorization and acceptance; patient care coordination, care progression and discharge planning; initial and continued stay clinical authorizations; inpatient denial mitigation and management; interdisciplinary high-risk patient management; census and throughput management; and daily reporting to executive leadership at Children\'s National Hospital and The Pediatric Center. Provides 24-hour accountability for these functions including weekend admissions and discharges. Qualifications
Minimum Education Bachelor\'s Degree in Health Administration, Social Work, Nursing, Business Administration or related discipline (Required) Master\'s Degree MSN, MBA, MSW, MHA or similar advanced degree (Preferred) Minimum Work Experience 5 years Case Management related experience including discharge planning, utilization review, clinical auditing, and financial/clinical data reporting. Nursing experience (Required) 3 years Supervisory or managerial experience (Preferred) Required Licenses and Certifications Registered Nurse (RN) license from the District of Columbia (Required) Specialty Certification - CCM (Preferred) Required Skills/Knowledge Knowledge of admissions processes, utilization review, discharge planning, case management, social work, care coordination and denial prevention and recovery methodologies Knowledge of healthcare administration and finance; knowledge of District and federal regulations and The Joint Commission regulations Knowledge of hospital risk management processes and performance improvement Ability to develop and maintain effective working relationships with physicians, hospital managers and interdisciplinary care team Ability to develop and maintain effective partnerships with referring hospitals, clinicians, programs, and payers Ability to negotiate and execute single case agreements with Managed Care and Revenue Cycle Strong verbal and written communication Ability to analyze clinical, financial and referral data to identify growth opportunities and measure impact Ability to plan and manage the work of others to achieve outcomes Ability to use complex computer applications including EMR, portals, medical management programs, denial reporting programs and referral management tools Working knowledge of Interqual and MCG guidelines Job Functions
Resource Management Plan for staffing 24/7 and continuously monitor and adjust staffing based on department needs Support Director with HR activities for assigned team including selection, performance evaluation input, remediation and training Accountable for staff timecards and schedules in Kronos Manage hiring by interviewing and recommending hires Lead initiatives, projects and committees for clinical growth and margin improvement Establish collaborative relationships and networks to ensure patient outcomes and volumes Update staff with organizational, case management, care coordination and utilization information Collaboratively define staff workflows, workload, priorities and resource allocation Clinical Resource Management Manage and report medical necessity denials to identify trends and action plans Support systems affecting patient throughput, length of stay, utilization management and discharge planning Lead recoveries of medical necessity-related appeals and implement process improvements to minimize denials and avoidable days Identify denial trends and escalation paths Discuss and plan actions around high-risk and long-stay patients to optimize outcomes while mitigating financial impact Revenue Cycle Management Assess revenue cycle phases to identify opportunities for improvement; collaborate to address DNFB, holds, work queues, charge capture and denial mitigation Work with Managed Care, Revenue Cycle and clinical providers on payer-specific issues Identify potential billing compliance issues; assess risk; coordinate with Compliance to resolve issues Work with Federal, State and local authorities on regulatory issues affecting claims submission and adjudication Communicate financial information to support decision making; develop effective communication with staff and patients/families Provide timely feedback to staff on performance; manage conflicts and support a respectful work environment Escalate clinical issues to Director and MUD as appropriate May perform other duties as needed Organizational Accountabilities
Leadership and Management Demonstrates commitment to quality of service and collaborates to achieve excellence Innovates to improve care and operational efficiency Maintains high standards of performance and safety Encourages diverse teams to communicate effectively and think creatively Drives collaboration to achieve goals efficiently Exhibits strong listening and feedback skills Leadership Skills Assumes responsibility for results and manages organizational change Empowers staff to uphold transparency, fairness, respect and excellence Aligns operational objectives with strategic goals Promotes trust and open communication within the team Supervisory Responsibilities Oversees general direction of staff members Protected Health Information Access Level Level IV – Full Access Physical Requirements Light work: lifting up to 25 lbs; frequent lifting up to 10 lbs Travel Requirements Full-time; regular hours with minimal travel Locations
Primary Location: District of Columbia-Washington Work Locations: Rehab and Specialized Care, 1731 Bunker Hill Road NE, Washington 20017 Job: Management Organization: HSC Pediatric Center Position Status: R (Regular) - FT - Full-Time Shift: Day Work Schedule: 8:30am-5:00pm, Monday-Friday; rotate weekend on-call Job Posting: Aug 15, 2025, 6:55:53 PM Full-Time Salary Range: 85,404.80 - 142,334.40 Equal Opportunity Notice: Children\'s National Hospital is an equal opportunity employer. The policy includes disclosures of rights and poster information; pay transparency and nondiscrimination details are available as applicable.
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