Case Manager RN-Utilization Review Casual Weekends

The salary range for this position is $40.50 - $64.80 (Hourly Rate)

Placement within the salary range is dependent on several factors such as relevant work experience and internal equity. For positions represented by a labor union, placement within the salary range is guided by the rules outlined in the collective bargaining agreement.

We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section located at jobs.nm.org/benefits to learn more.

Northwestern Medicine is powered by a community of colleagues who are purpose-driven and committed to our mission to deliver world-class care. Here, you'll work alongside some of the best clinical talent in the nation leading the way in medical innovation and breakthrough research with Northwestern University Feinberg School of Medicine.

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Create the life you envision for yourself with flexible work options, a Reimbursable Well-Being Fund and a Total Rewards package that support your physical, mental, emotional, and financial well-being.

Make a difference through volunteer opportunities we offer in local communities and drive inclusive change through our workforce-led resource groups.

From discovery to delivery, come help us shape the future of medicine.

Description

**This is a casual (non benefited) position supporting our Case Management UR department at Northwestern Medicine Catherine Gratz Griffin Lake Forest Hospital. This role would be working remotely with requirement to work every other weekend (Saturday and Sunday.) **

The Case Manager RN UR/Bed Planner 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.

Responsibilities:

• Determines the most appropriate level of care and admission status and applies approved criteria and guidelines in decision making, as well as managed care rules and practices in order to ensure a smooth admission experience for patients by coordinating clinical needs with operational processes and insurance benefits.
• Collaborates with the attending physician on appropriate hospital status orders.
• The clinical admission nurse does not provide direct patient care.
• Chart review is used to assess for appropriate level of care and admission status.
• Assigns patients to the appropriate units based on clinical assessment while balancing the resources of the organization.
• Coordinates with unit charge nurse for bed placement.
• Collaborates with nursing operations leader for throughput issues.
• Serves as an access point resource for physicians, staff, and patients.
• Responds to and assigns all bed request and transfer orders in the electronic medical record.
• Documents unusual occurrences and patient relations issues; makes appropriate referrals to risk management, infection control and quality departments.
• Evaluates and analyzes quality/utilization cases, admission/discharge criteria, observation/1-day stays, readmits in 30 days, Medicare and diagnosis related criteria.
• Consults with physicians in assigning admission level of care status.
• Stays up-to-date on Medicare rules and regulations for hospital admission status.
• Performs medical record review to assess for appropriateness of admissions and works with the Emergency Room and attending physicians to divert unnecessary admissions.
• Monitors and documents avoidable days and recommends change in services or processes.
• Responds to requests by the denials management RN for appeal assistance.
• Utilizes appropriate downtown procedures for bed placement when applicable.
• Assists with data collection and reporting for throughput and bed placement.
• Performs chart audits as requested by manager/director.

AA/EOE.

Qualifications

Required:

• Registered Nursing license issued by the State of Illinois.
• Bachelor's of Science in Nursing.
• At least two to five years of patient care experience in a hospital setting.
• Able to multi task quickly, and process multi factorial stimulation accurately.
• Critical thinking skills, decisive judgment, and the ability to work with minimum supervision.
• Past experience in admissions, utilization review activities, discharge planning, and/or case management.

Preferred:

• Utilization Review experience.
• Master's of Science in Nursing.
• Membership in Professional Nursing Organization.
• Certification in Case Management (ACM).

Equal Opportunity

Northwestern Medicine is an equal opportunity employer (disability, VETS) and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.

Background Check

Northwestern Medicine conducts a background check that includes criminal history on newly hired team members and, at times, internal transfers. If you are offered a position with us, you will be required to complete an authorization and disclosure form that gives Northwestern Medicine permission to run the background check.  Results are evaluated on a case-by-case basis, and we follow all local, state, and federal laws, including the Illinois Health Care Worker Background Check Act.

Artificial Intelligence Disclosure

Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person. 

Benefits

We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events. Please visit our Benefits section to learn more.

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.