Job Description - Nurse Lead - Colorectal Surgery - DC (240002D5)
Description
All nursing practice is based on the legal scope of practice, national and specialty nursing standards, CNMC Policies and Procedures, and in accordance with all applicable laws and regulations. The Professional Model of Care requires registered professional nurses to be responsible and accountable for their own practice. CNMC supports the development of RN relationships within the community; specifically, those relationships associated with the health and well-being of the community at large. Responsible for daily operations (staffing and assignments) and directing the activities of the Clinical Resource Management department. Provides 24-hour accountability for planning, managing and evaluating department functions. Guides, supervises and elevates the quality of practice for utilization review within Children's National. Key areas of focus include use of nationally recognized criteria sets, status changes and concurrent denial management.
Qualifications
Minimum Education
Bachelor's Degree (Required)
Master's Degree (Preferred)
Minimum Work Experience
5 years Nursing experience (Required)
1 year Pediatric experience in a comparable setting (Required)
1 year Demonstrated nursing leadership experience (Required)
Required Skills/Knowledge
Familiar with software such as Windows environment (Microsoft Office, Word, PowerPoint, Excel, Access).
Excellent oral and written communication skills.
Fluent in medical management criteria such as MCG and/or InterQual.
Required Licenses and Certifications
Registered Nurse in District of Columbia.
Functional Accountabilities
Professional Practice/Research
- 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.
Daily Operations- 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.
Communication- 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.
Staff Education- Facilitate learning opportunities for staff.
- Participate in the education and training of Case Managers and other staff.
Safety
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