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Thanks for your interest in Children's Mercy!

Do you envision finding a meaningful role with an inclusive and compassionate team? At Children’s Mercy, we believe in making a difference in the lives of all children and shining a light of hope to the patients and families we serve. Our employees make the difference, which is why we have been recognized by U.S. News & World Report as a top pediatric hospital, for eleven consecutive years.

Children’s Mercy is in the heart of Kansas City – a metro abounding in cultural experiences, vibrant communities and thriving businesses. This is where our patients and families live, work and play. This is a community that has embraced our hospital and we strive to say thanks by giving back. As a leader in children’s health, we engage in meaningful programs and partnerships throughout the region so that we can improve the lives of children beyond the walls of our hospital.

Overview

The High-Risk Nurse Lead manages high risk administrative processes and data related to medical necessity denials, clinical appeals, long length of stay rounds, and clinically/financially risky patients. Uses data tools and tracking to monitor status and outcomes of denials and appeals to identify trends and opportunities for the patient population, hospital, care delivery model, care management practices, and payer contracting. Supports facilitation and tracking of long length of stay patients including total charges, barriers to transition, and intervention plans. Monitors and tracks patients with financial/clinical risks that need multidisciplinary action to address and resolve issues. The High-Risk Nurse Lead is an expert at the roles of Clinical Review Nurse Care Manager and Care Coordination Case Manager and provides support to larger team in addressing and resolving role-specific concerns. This role improves efficiency and reduces health care costs as evidenced by decreased lengths of stay, decreased readmissions, decreased denials, and increased patient satisfaction.

At Children’s Mercy, we are committed to ensuring that everyone feels welcomed within our walls. A successful candidate for this position will join us as we strive to create a workplace that reflects the community we serve, as well as our core values of kindness, curiosity, inclusion, team and integrity.

Additionally, it’s important to us that we remain transparent with all potential job candidates. Because we value the safety of the patients and families we serve, as well as the Children’s Mercy staff, we want to let you know that the seasonal influenza vaccine is a condition of employment for all employees in our organization. New employees must be willing to be vaccinated if found non-immune to measles, mumps, rubella (MMR) and chicken pox (varicella) and/or without evidence of tetanus, diphtheria, acellular pertussis (Tdap) vaccination since 2005. If you are selected for this position, you will be asked to supply your immunization records as proof of vaccination. If you and have any concerns about receiving these vaccines, medical and/or religious exemptions can be further discussed with Human Resources.

Responsibilities

+ Accountable to track all concurrent medical necessity denials through the verbal reconsideration, written appeal, and final appeal outcome to identify and resolve insurance/payer issues; clinical care delivery concerns; Care Coordinator performance improv

+ Assists management in long length of stay rounds to track extended stay patients that pose financial risk to the organization.

+ Engages with Care Management Department and Leadership for early escalation of patients presenting to hospital or placed in hospital with concerns for progression of care due to clinical, financial, social and payment barriers.

Qualifications

+ Bachelor's Degree BSN and

+ 3-5 years experience

+ Experience as a care manager or demonstrated leadership skills in a previous role

+ One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon hire

+ One of the following: Licensed RN - Kansas, Registered Nurse Multistate License Kansas required upon hire

+ One of the following: American Case Management, Certified Case Manager required upon hire

+ RN Compact license for all states besides KS and MO

+ Must Obtain KS or MO compact within 60 days of hire

+ One of the following: American Case Management Certification or Certified Case Manager

+ Employees must obtain American Case Management or equivalent within 365 days

+ Employees must obtain Certified Case Manager or equivalent within 365 days

+ Refer to Nursing and Advanced Practice Provider Licensure and Certification policy for required Life Support Certifications Required Upon Hire

Benefits at Children's Mercy

The benefits plans at Children’s Mercy are one of many reasons we are recognized as one of the best places to work in Kansas City. Our plans are designed to meet the changing needs of our employees and their families.

Learn more about Children’s Mercy benefits. (https://www.childrensmercy.org/careers/why-childrens-mercy/employee-benefits/)

Starting Pay

Our pay ranges are market competitive. The pay range for this job begins at $36.75/hr, but your offer will be determined based on your education and experience.

Remote Work/Work from Home

This position is not eligible to work remotely, which means that the person hired will be required to work onsite at one of our Children’s Mercy locations and may not work from home.

EEO Employer/Disabled/Vet

Children’s Mercy hires individuals based on their job skills, expertise and ability to maintain professional relationships with fellow employees, patients, parents and visitors. A personal interview, formal education and training, previous work experience, references and a criminal background investigation all are factors used to select the best candidates. The hospital does not discriminate against prospective or current employees based on the race, color, religion, sex, national origin, age, disability, creed, genetic information, sexual orientation, gender identity or expression, ancestry or veteran status. A drug screen will be performed upon hire. Children’s Mercy is smoke and tobacco free.

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Requisition ID2025-33710

Requisition Post Information* : Posted Date1 month ago(6/17/2025 4:23 PM)

Posting CategoryNursing

DivisionCARE MANAGEMENT

Work TypeFull Time

Work DaysMon- Fri

Work Hoursvaries 0730-1730

FLSA StatusExempt

Location : NameAdele Hall

Recruiter : Full Name: First LastAngela Brown

Recruiter : [email protected]