Utilization Review Case Manager RN-Emergency Department Full Time Days

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.

We recognize where you've been, and we support where you're headed. We celebrate diverse perspectives and experiences, which fuel our commitment to equity and culture of service.

Grow your career with comprehensive training and development opportunities, mentorship programs, educational support and student loan repayment.

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

The Emergency Department (ED) Utilization Review (UR) Case Manager RN 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:

• Utilizes advanced clinical skills to perform utilization review on patients admitted through the Emergency Department.
• Maintains current knowledge of clinical criteria sets and evidence-based research around utilization review.
• Promotes and evaluates the effective utilization of resources using current clinical knowledge to achieve optimal clinical and resource outcomes.
• Performs Medical Necessity Outreach (MNO) with providers to clarify severity of illness and intensity of services offered.
• Build rapport with ED provider staff.
• Document the medical necessity for the observation status in the electronic medical record.
• Monitors electronic medical record track board for eligible patients.
• Places hospital status orders in collaboration with ED providers.
• Documents unusual occurrences and patient relations issues; makes appropriate referrals to risk management, infection control and quality departments.
• Collaborates with the ED Case Manager/Social Worker on patient specific discharge planning, safety, or clinical concerns of a patient that is being reviewed.
• Partners with manager/director in evaluating and analyzing quality/utilization cases, admission/discharge criteria, ED observation cases, and ED to Observation data.
• Consults with physicians in assigning admission level of care status and uses physician advisory group as needed.
• Stays up-to-date on Medicare rules and regulations for hospital.
• Performs medical record review to assess for appropriateness of admissions.
• Monitors and documents avoidable days and recommends change in services or processes.
• Develops and educates staff on clinical practice guidelines/Protocols/pathways that complement industry standards to reduce unnecessary admissions, ED length of stay and resource consumption while maintaining quality of care.
• Monitors documentation of an appropriate diagnosis for outpatient/observation testing to pass medical necessity. Educates ED physicians on documentation best practice.

Qualifications

Required:

• Registered Nursing license issued by the State of Illinois.
• Bachelor of Science in Nursing.
• 3 or more years of related clinical or utilization review experience.

Preferred:

• Master of Science in Nursing.
• Membership in Professional Nursing Organization.
• Certification in Case Management (ACM or CCM).
• 5 or more years of clinical or utilization review experience

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: 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.