Clinical Resource Management Nurse Lead
Children's National Hospital
Summary
As the Clinical Resource Management Nurse Lead, you'll provide day-to-day leadership for the Clinical Resource Management department, overseeing staffing, assignments, and daily operations while maintaining 24-hour accountability for planning, managing, and evaluating department functions. You'll guide and supervise utilization review practice across Children's National, helping elevate quality and consistency through the use of nationally recognized criteria sets. Key areas of focus include managing status changes, supporting concurrent denial management, and promoting effective utilization review practices that help ensure appropriate, high-quality care.
Job description
What You'll Do
As the Clinical Resource Management Nurse Lead, you'll provide day-to-day leadership for the Clinical Resource Management department, overseeing staffing, assignments, and daily operations while maintaining 24-hour accountability for planning, managing, and evaluating department functions. You'll guide and supervise utilization review practice across Children's National, helping elevate quality and consistency through the use of nationally recognized criteria sets. Key areas of focus include managing status changes, supporting concurrent denial management, and promoting effective utilization review practices that help ensure appropriate, high-quality care.
Functional Accountabilities
- Facilitate the CMI practice group of Shared Nursing Leadership and support other initiatives.
- Contribute to the sustainability and advancement of Magnet designation.
- Ensure that utilization review for patient status (IP and Observation) is based on evidence of best practice.
- Accountable for supporting/participating in the CRM and/or Division of Nursing's Performance Improvement processes.
- Participate in community activities.
- Accountable for staffing and assigning coverage for all roles within CRM; engages with CMI Team Lead, Manager & Director to problem solve.
- Responsible for 24/7 assessment and supervision of work flow for CMI's and support positions.
- Supervise utilization review activities, interface with internal and external stakeholders to achieve appropriate level of care and optimize reimbursement; ensure compliance with CMS regulations.
- Interact with payors and CRM leadership to improve the authorization process.
- Engage in performance improvement activities to standardize and elevate practice.
- Demonstrate advanced communication skills in dealing with staff and all members of the healthcare team.
- Provide constructive, sensitive and timely feedback to staff concerning their performance in verbal and written form.
- Effectively manage conflict and assist others to understand their behavior and their effect on the work environment.
- Communicate and escalate issues as appropriate to the Manager and Director.
- Facilitate learning opportunities for staff.
- Participate in the education and training of Case Managers and other staff.
Requirements
- Bachelor's Degree (Required)
- Master's Degree (Preferred)
- Five (5) years' experience (Required)
- One (1) year pediatric experience in a comparable setting (Required)
- One (1) year demonstrated nursing leadership experience (Required)
- Extensive clinical experience in Case Management and/or Utilization Management (Preferred)
- Familiar with software such as Window's environment (Microsoft Office, Word, PowerPoint, Excel, Access)
- Excellent oral and written communication skills
- Fluent in medical management criteria such as MCG and/or InterQual
- Registered Nurse license in DC (Required)
Benefits
- Comprehensive health coverage
- Prescription services
- Infertility services
- Transgender health services
- Paid time off
- Vacation accrual
- Sick leave
- Holidays
- Personal day
- 401(k) plan
- Healthcare spending accounts
- Dependent care spending accounts
- Life insurance
- AD&D insurance
- Long-term disability coverage
- Tuition assistance
- Fitness resources
- Employee assistance program
- Commuter benefits
Company overview
Children's National Hospital is a premier pediatric healthcare institution located in Washington, D.C., recognized as one of the top children's hospitals in the United States. Founded in 1870, it serves as the region's primary pediatric academic medical center, providing comprehensive care across all pediatric specialties. The hospital operates a 323-bed facility and offers advanced medical services including neonatal intensive care, pediatric surgery, oncology, cardiology, and neurology. As an academic medical center affiliated with the George Washington University School of Medicine and Health Sciences, Children's National is deeply involved in pediatric research, medical education, and clinical innovation. The institution is particularly renowned for its Sheikh Zayed Institute for Pediatric Surgical Innovation and its leadership in pediatric genomics and precision medicine. Children's National consistently ranks among the top pediatric hospitals nationally, with specialties in cancer, cardiology, neurology, and neonatology receiving particular recognition for excellence in patient care and outcomes.