[Hiring] Case Manager RN-Utilization Review @Northwestern Memorial Healthcare

Role Description

This is a remote casual position supporting Utilization Review at Catherine Gratz Griffin Lake Forest Hospital. This position is to provide additional staffing coverage for the department and does not have a set schedule. Looking for someone who is able to work weekdays and weekends. Scheduled for this role is 6a to 6p or 6p to 6a.

The Case Manager, RN (PT) reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

• Develops individualized treatment plans for patients, in collaboration with the patient and their family.
• Coordinates and leads care conferences on patients with length of stays greater than 7 days.
• Documents unusual occurrences and patient relations issues; makes appropriate referrals to risk management, infection control and quality departments.
• Assesses patient and family needs for appropriate discharge services.
• Coordinates transfer to appropriate level of care such as skilled care, rehabilitation, custodial and home health care.
• Documents discharge planning on the interdisciplinary plan of care, in progress notes and education record.
• Maintains current knowledge of resources available in the community to support a continuum of effective services for the patient.
• Delivers notice of Medicare discharge appeal rights within the appropriate time frame.
• Assists physician in assigning admission status.
• Performs medical record review to assess for appropriateness of admissions and continued hospital stay.
• Monitors avoidable days and recommends change in services or processes.
• Educates staff on CPG/Standing Orders/Protocols that complement industry standards to reduce length of stay and resource consumption while maintaining quality of care.
• Ensures compliance with managed care contracts and length of stay targets while maintaining quality of care.
• Develops and educates staff on CPG/Standing Orders/Protocols that complement industry standards to reduce length of stay and resource consumption while maintaining quality of care.
• Distributes hospital issued non coverage notices.
• Monitors documentation of an appropriate diagnosis for outpatient/observation testing and queries physicians/APPs as needed following AHIMA guidelines.
• Responds to requests by patient financial services for appeal assistance.
• Supports Denials Lead RN on Appeals insurance denials for medical necessity for inpatient and outpatient services.
• Completes documentation worksheet.
• Queries physician for clarification or missing documentation.
• Performs chart audits for documentation compliance with CMS standards.
• Obtains appropriate documentation to comply with core measure standards.

Qualifications

• Registered Nursing license issued by the State of Illinois.
• Bachelors of Science Nursing.
• 3 or more years of related clinical experience.

Requirements

• Masters of Science Nursing (Preferred).
• Membership in Professional Nursing Organization (Preferred).
• Certification in Case Management (ACM) (Preferred).

Benefits

• Wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being.
• Protection for unexpected life events.
• Sign-on Bonus Eligibility (if sign-on bonus offered for position): Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign on bonus. Exception: New graduate internal employees seeking their first licensed clinical position at NM may be eligible depending upon the job family.