RN Case Manager Hybrid I/II

Children's National Hospital

4d • $77,584 - $129,293 • Hybrid

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 Case Manager Hybrid I/II at Children’s National Hospital, you will serve at the heart of patient care, acting as a vital advocate and coordinator for children and their families. In this impactful role, you will lead both discharge planning and utilization review efforts, ensure a seamless, high-quality care experience while promoting continuity and positive outcomes for complex, chronic, and high-risk patients. Partnering closely with interdisciplinary teams, you will guide care planning discussions, address barriers such as social determinants of health, and connect families with essential community and financial resources, including Medicaid, Medicare, and other programs. You will manage a panel of patients, using data-driven insights to reduce avoidable admissions, proactively prevent readmissions, and optimize resource utilization. As a central hub across the care continuum, you will also review and authorize hospital days to ensure alignment with payer guidelines, helping minimize denied claims while supporting effective, efficient care delivery. This is a meaningful opportunity to make a lasting difference—empowering families, strengthening care coordination, and advancing better health outcomes for every child you serve.

Requirements

• Bachelor’s Degree (Required)
• Five (5) years’ experience with at least three (3) years in an acute inpatient setting (Required)
• Experience in one or more of the following areas: designate/pediatric specialty, program/project development clinical pathways, and leadership (Required)
• Registered Nurse license in DC (Required)

Nice To Haves

• Master’s Degree (Preferred)
• Extensive clinical experience in Case Management and/or Utilization Management (Preferred)
• Current certification in Case Management or Utilization Management (Preferred)

Responsibilities

• Lead and proactively define discharge and transitional care criteria daily with the healthcare team to facilitate efficient care transitions.
• Conduct an initial assessment within 1 day of patient and family to identify potential discharge barriers and needs in accordance with departmental and regulatory requirements.
• Document in EHR and escalate timely to leadership any barriers.
• 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/referrals to third party payers using nationally recognized medical necessity criteria and validate authorization or denial of services and document appropriately in EHR (Initial Assessment & ongoing assessment).
• Follow High Risk Process (Uninsured/Social/Financial Risk).
• Monitor Length of Stay (LOS) and Document Avoidable Days/Delays for all patients assigned.
• Timely handoff to teams (nursing/CM/Provider) to ensure continuity of care for all patients.
• Document according to departmental policy.
• Abide by nursing practice guidelines.
• Initial Assessment 1-2 days of admission and Ongoing assessment weekly.
• Document daily if needed as ongoing patient care management occurs.
• Document parent guardian choice for each patient with a case management need (ex: DME/PDN/Placement etc).
• 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.
• Identify gaps in care coordination, discharge planning, and resource utilization.
• Ensure adherence to regulatory and accreditation standards (e.g., CMS, Joint Commission, DOH).
• Work closely with other case managers, social workers, physicians, payors and nursing staff.
• Utilize department tools to track key performance indicators (KPIs) such as length of stay (LOS), Avoidable days, readmission rates, and care transitions.
• Effectively manage patent ratio of 1:30 for safe discharge.

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