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Registered Nurse (RN) - Manager, Utilization Review - $35-38 per hour

Company: Children's National Hospital
Location: Washington
Posted on: March 19, 2023

Job Description:

Children's National Hospital is seeking a Registered Nurse (RN) Manager, Utilization Review for a nursing job in WASHINGTON, District of Columbia.Job Description & Requirements

  • Specialty: Utilization Review
  • Discipline: RN
  • Start Date: ASAP
  • Duration: Ongoing
  • 40 hours per week
  • Shift: 8 hours
  • Employment Type: Permanent

    This position will manage activities and staff of the Utilization Review and Clinical Documentation Improvement departments. Supervise and evaluate the daily work of these teams in accordance with departmental and organizational policies. Provide education within the departments 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. Monitor the performance, collection and analysis of data to report on the effectiveness of process improvement to the organization and department. Participate in the planning, development and implementation, and ongoing success of the Clinical Documentation Management Program. Educate members of the patient care team regarding documentation guidelines, including attending physicians, nursing, and other interdisciplinary team members.
    Minimum Education Master's Degree in Nursing (Required) Minimum Work Experience 7 years Healthcare experience (Required) 3 years Supervisory experience (Required) 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 (Required) Basic Life Support for Healthcare Provider (BLS) (Required) CCDS or CDIP (Preferred) Case Management Certification (CCM or CMSA) (Preferred) Functional Accountabilities Operations
    Management - General - Supervise and evaluate the daily work in accordance with departmental and organizational policies. - Manage staffing to ensure adequate coverage and optimize productivity. Assign coverage and deploy staff accordingly. - Participate in budget development and recommend budgets for areas of oversight. - Track spending for areas of oversight. Operations Management - Clinical Resource Management (CRM)/Utilization Review (UR) - As a subject matter expert on Interqual and MCG guidelines, function as a resource to staff and intervene to resolve issues that arise internally and with payors. - Mentor staff and support learning opportunities to foster success. - Work directly with payors and Managed Care to enhance communication and improve authorization processes. - Assist with the management of denials and High Risk cases. Operations Management - Clinical Documentation Improvement (CDI) - Partner with coding leadership to monitor trends and mismatches
    Childrens National Job ID #2300004J. Posted job title: RN - Utilization Review, ManagerAbout Children's National HospitalChildren's National Hospital, based in Washington, D.C., celebrates 150 years of pediatric care, research and commitment to community. Volunteers opened the hospital in 1870 with 12 beds for children displaced after the Civil War. Today, 150 years stronger, it is among the nation's top 10 children's hospitals. It is ranked No.1 for newborn care for the fifth straight year and ranked in all specialties evaluated by U.S. News & World Report. Children's National is transforming pediatric medicine for all children. In 2021, the Children's National Research & Innovation Campus opened, the first in the nation dedicated to pediatric research. Children's National has been designated three times in a row as a Magnet-- hospital, demonstrating the highest standards of nursing and patient care delivery. This pediatric academic health system offers expert care through a convenient, community-based primary care network and specialty care locations in the D.C. metropolitan area, including Maryland and Virginia. Children's National is home to the Children's National Research Institute and Sheikh Zayed Institute for Pediatric Surgical Innovation and is the nation's seventh-highest NIH-funded children's hospital. It is recognized for its expertise and innovation in pediatric care and as a strong voice for children through advocacy at the local, regional and national levels.Benefits
    • Medical benefits
    • Dental benefits
    • Vision benefits
    • Health Care FSA
    • Life insurance
    • 401k retirement plan
    • Employee assistance programs

Keywords: Children's National Hospital, Washington DC , Registered Nurse (RN) - Manager, Utilization Review - $35-38 per hour, Healthcare , Washington, DC

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