Nurse Clinical Resource Management Supervisor

Clinical Resource Management is responsible for the leadership and day-to-day operations of the Collaborative Services team members 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 all 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; specifically, those relationships associated with the health and well-being of the community ponsible for directing the activities of 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; overall 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.

Minimum Education

Bachelor's Degree Health administration, social work, nursing, business administration or related discipline. (Required)

Master's Degree MSN, MBA, MSW, MHA or similar relevant 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 Upon Hire (Required)

Specialty Certification- CCM (Preferred)

Required Skills/Knowledge

* Knowledge of best practices as it relates to admissions processes, utilization review, discharge planning, case management, social work, care coordination and denial prevention and recovery methodologies.

* Knowledge of the principles of health care administration and health care finance; thorough knowledge of District and federal regulations and The Joint Commission regulations for hospitals and nursing homes.

* Knowledge of hospital risk management processes and performance improvement methodology

* Ability to develop and maintain effective working relationships with physicians, hospital managers, and other members of the interdisciplinary care team

* Ability to develop and maintain effective partnerships with referring hospitals, clinicians, and programs as well as public and private payers

* Ability to negotiate and execute single case agreements in collaboration with Managed Care and Revenue Cycle

* Strong communication skills both verbal and written

* Ability to organize, assemble, categorize and analyze clinical, financial and referral data to identify opportunities for growth and measure impact of expansion efforts

* Ability to plan and manage the work of others to achieve measurable clinical and financial outcomes

* Ability to effectively use complex computer applications including electronic medical records, portals, medical management programs, denial reporting programs, and referral management tools

* Working knowledge of industry standard medical management guidelines such as Interqual and MCG

* Sound professional judgment, dependability, tact, discretion, integrity, resourcefulness, accuracy and initiative.

Job Functions

Resource Management

* Accountable to plan for staffing 24/7; continuously monitor and adjust staffing based on department needs.

* Support the Director with human resource activities of assigned team members including selection, input on performance evaluation, remediation & training.

* Accountable for assigned staff timecards and schedules in the Kronos system.

* Manage hiring of staff by conducting interviews and making recommendations for hire.

* Lead initiatives, projects, and committees aimed at clinical growth and margin improvement.

* Establish collaborative relationships and networks across the enterprise and the region to ensure effective patient outcomes and sustained patient volumes.

* Update staff with relevant organizational, community, case management, care coordination, and utilization information via written communication and staff meetings.

* Collaboratively define staff workflows, workload, priorities, and resource allocation across the enterprise

Clinical Resource Management

* Actively manage and report medical necessity denials to identify trends and specific issues that need action plans for resolution at the aggregate or individual level.

* Support systems that impact patient throughput, length of stay, utilization management & discharge planning.

* Lead recoveries of medical necessity-related appeals utilizing…