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
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.
Qualifications
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
Keywords: Children's National Hospital, Washington DC , Registered Nurse (RN) - Manager, Utilization Review - $35-38 per hour, Healthcare , Washington, DC
|
Click
here to apply!
|
