Nurse Manager, Clinical Resource & Community Care - Full Time - DC

Children's National Medical Center - Washington, DC

Full-time - Mid Level

Washington, DC

501-1,000 employees

Hospitals

About the position

The Nurse Manager, Clinical Resource & Community Care Management at HSC Health Care System is a pivotal role that combines leadership, clinical expertise, and operational management to enhance the quality of care for children and young adults with special health care needs. Reporting to the Director of Integrated Care Management, the Nurse Manager will oversee the daily operations of the Children's National Rehabilitation and Specialized Care Nurse Care Management and Social Work team, as well as Community Health Programs. This position is essential in ensuring that care management practices align with departmental and organizational policies, ultimately improving patient outcomes and operational efficiency. In this role, the Nurse Manager will be responsible for providing education within both inpatient settings and community health programs. This includes educating staff on clinical care, levels of care, and financial issues that impact service delivery. The Nurse Manager will lead clinical and financial processes that affect authorization for inpatient and outpatient services, manage net collections for hospital-based services, and oversee pay-for-performance projects in ambulatory settings. A critical aspect of this position involves analyzing and reporting data related to case management activities, payer activities, resource utilization, and clinical denials, thereby driving hospital-wide initiatives that enhance care management. The Nurse Manager will also play a key role in defining care management practices that optimize performance outcomes, focusing on readmission prevention, low acuity non-emergency (LANE) emergency department avoidance, and reducing inpatient length of stay. This comprehensive approach to care planning supports the highest level of symptom management across various settings, including home, school, community, and ambulatory clinics. The position requires a strong commitment to the mission of HSC Health Care System, which emphasizes innovative, high-quality, community-based care for individuals with complex needs and their families.

Responsibilities

• Lead, supervise, and evaluate the daily work of the Children's National Rehabilitation and Specialized Care Nurse Care Management and Social Work team.
• Provide education on clinical care, levels of care, and financial issues within inpatient and community health programs.
• Manage clinical and financial processes impacting authorization for inpatient and outpatient services.
• 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 to improve care management practices.
• Optimize performance outcomes through readmission prevention and reducing inpatient length of stay.
• Collaborate with Managed Care and other stakeholders to address payer-specific issues.
• Oversee human resource activities including staff selection, training, and performance evaluation.
• Promote an environment that supports and recognizes team contributions.
• Identify potential billing compliance issues and work with the Compliance Department to resolve them.

Requirements

• Master's Degree in Nursing or equivalent (Required)
• 7 years of clinical nursing experience (Required)
• 5 years of case management experience including care coordination, discharge planning, and utilization review (Required)
• 3 years of supervisory experience with executive level leadership (Preferred)
• Excellent written and verbal communication skills
• Knowledge of children's health issues and cultural impacts on healthcare
• Experience with medical management criteria such as MCG and/or InterQual
• Ability to analyze and present complex financial and productivity data using software tools
• Experience with Cerner systems preferred.

Nice-to-haves

• CCM or ACMA certification (certified case manager) (Preferred)
• Experience in managing day-to-day operations of case management functions in a medical center.

Benefits

• Health insurance
• Dental insurance
• Vision insurance
• 401k retirement plan
• Paid time off
• Continuing education support
• Life insurance
• Flexible scheduling options
• Employee discount programs