Case Manager II

Children's National Hospital

5d • $87,173 - $145,267 • Onsite

About The Position

Case Managers work within all areas of Children’s National including Inpatient Units, Psychiatry, PACU, ED, Children's Health Center, Admissions, and Business Operations. Children's Clinical Resource Management/Case Management program is recognized as a national best practice leader in care coordination and financial stewardship. Case Managers are the experts at finding resources and care to meet our patients' needs across the healthcare continuum while ensuring optimal reimbursement so we can all thrive on giving children the best chance at a bright future.

As a member of our case management team, you will make a meaningful impact in the lives of patients and families every day! As a Case Manager II, you will play a vital role in delivering comprehensive, compassionate care by supporting patients and their families or caregivers throughout their healthcare journey. In this role, you will provide professional case management services that focus on assessing individual needs, contributing to care planning, and implementing targeted interventions designed to improve outcomes. You will work collaboratively with multidisciplinary teams to ensure seamless coordination of services, while also maintaining a strong focus on follow-up care to support continuity and long-term success. Beyond direct patient support, you will extend your impact into the community by engaging in outreach activities that connect families to essential resources and services. Your ability to build relationships, advocate for patient needs, and navigate complex care environments will be critical to ensuring each patient receives the highest level of support. At Children’s National, you’ll be part of an organization committed to excellence, innovation, and compassionate care.

Requirements

• Master’s Degree (Required)
• Five (5) years’ experience with at least three (3) years in an acute inpatient setting (Required)
• Registered Nurse license in DC (Required)

Nice To Haves

• Previous experience in one or more of the following areas: case management, designated/pediatric specialty, program/project development, utilization management, clinical pathways, and leadership, preferred.
• Current certification in Case Management or Utilization Management (Preferred)

Responsibilities

• Participate in Shared Leadership.
• Contribute to the MAGNET Journey of Children’s National.
• Ensure nursing practice is based on evidence of best practice.
• Accountable to participate in the Nursing Division’s Performance Improvement process (division or unit level).
• Participate in community activities.
• Communicate denials, high risk, or changes in level of care using accepted processes to limit financial risk to CNMC and patients’ families.
• Navigate internal and external systems to accurately identify or secure payers and link patients to needed services.
• Define discharge and transitional care criteria with the healthcare team to facilitate efficient care transitions.
• Conduct an initial assessment of patient and family to identify potential discharge barriers and needs in accordance with departmental and regulatory requirements.
• Develop and implement a plan of care and make referrals based on a needs assessment and available resources in conjunction with care team members.
• Transition care to external providers and services to achieve quality outcomes for patient and family.
• Provide clinical reviews to third party payers using nationally recognized criteria and validate authorization or denial of services and document appropriately in STAR.
• Identify, implement, and evaluate processes to improve customer service, reimbursement and/or hospital performance
• Participate in the identification of PI issues and take steps to improve unit or CRM processes.
• Promote the development of CRM department and other members of the healthcare team.
• Document according to departmental policy.
• Identify, implement, and evaluate processes to improve customer service, reimbursement and/or hospital performance.
• Participate in the identification of Process Improvement issues and take steps to improve unit or CRM processes.
• Promote the development of CRM department and other members of the healthcare team.

Benefits

• Comprehensive health coverage, including medical, prescription, infertility, and transgender health services.
• Generous paid time off, including vacation accrual from day one, sick leave, holidays, and a personal day.
• Financial wellness support, including a 401(k) plan and healthcare and dependent care spending accounts.
• Employer-paid life, AD&D, and long-term disability coverage, with optional supplemental plans.
• Additional perks, including tuition assistance, fitness resources, employee assistance, commuter benefits, and more.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level