111 Michigan Avenue Northwest
Washington, DC 20010
Kids Are Our Everything.
Department
10298 Case Management
Pay Range
$37.30 - $62.16
This is a PRN (as needed) position.
Who We Are:
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.
What You’ll Do:
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.
What You'll Need:
Minimum Education
Bachelor’s Degree (Required)
Master’s Degree (Preferred)
Minimum Work Experience
Five (5) years’ experience with at least three (3) years in an acute inpatient setting (Required)
Extensive clinical experience in Case Management and/or Utilization Management (Preferred)
Experience in one or more of the following areas: designate/pediatric specialty, program/project development clinical pathways, and leadership (Required)
Required Licenses and Certifications
Registered Nurse license in DC (Required)
Current certification in Case Management or Utilization Management (Preferred)
Functional Accountabilities
Professional Practice/Research
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.
Patient Resource Services
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.
Discharge Transitional Plan of Care
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…