Manager, Case Management Full-Time Days

At Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, you'll have the opportunity to join our quest for better healthcare, no matter where you work within the Northwestern Medicine system. At Northwestern Medicine, we pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, we take care of our employees. Ready to join our quest for better?

Benefits

• $10,000 Tuition Reimbursement per year ($5,700 part-time)
• $6,000 Student Loan Repayment ($3,000 part-time)
• $1,000 Professional Development per year ($500 part-time)
• $250 Wellbeing Fund per year($125 for part-time)
• Annual Employee Merit Increase and Incentive Bonus
• Paid time off and Holiday pay

Description

The Manager, Case Management 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:

• Collaborates with the department director to develop goals and objectives for area(s) of responsibility which are aligned with foundation strategic plan and/or organizational goals.
• Establishes key performance indicators utilizing industry or historical benchmarks; develops and implements a continuous quality improvement plan designed to improve performance.
• Is accountable for customer relations within area(s) or responsibility, including the appearance of the department and the manner in which staff communicate with patients, families, physicians, volunteers and other employees.
• Ensures departmental compliance with regulations, statutes and other applicable laws regarding operation and record retention.
• Maintains patient satisfaction scores consistent with the organizational goal.
• Facilitates growth and development of staff, including opportunities to learn new skills and advance both personally and professionally; ensures staff completion of required competencies and review of key policies and procedures.
• Provides oversight for Case Management.
• Monitors, evaluates and counsels departmental personnel regarding their performance on a consistent and regular basis between formal performance evaluations; prepares and maintains adequate documentation to support any progressive corrective action.
• Motivates employees to work productively in the work team.
• Encourages employee participation in problem resolution activities.
• Assists Director with preparing operating and capital budgets designed to meet individual, departmental and organizational strategies and goals; recommends and implements new initiatives and improvements to existing programs.
• Competent in Requisition management, PeopleSoft reporting, Kronos/Visionware, and financial programs needed for management of departments.
• Monitors financial performance versus budget; prepares monthly written reports and explains variances.
• Ensures that payroll and accounts payable invoices are reviewed, approved, coded and processed in accordance with fiscal policies and procedures.
• Maintains staffing levels consistent with benchmarks and productivity data available through professional associations.
• Develops an appropriate staffing plan for the Case Management Departments based on established industry metrics.
• Ensures effective staffing of the department. Develops and monitors schedules appropriately.
• Collaborates with other managers and directors in the hospital to continually improve patient flow and satisfaction.
• Works with clinical departments to ensure that correct CPT codes are used when checking for medical necessity.
• Trains and supervises department staff on medical necessity and order management.
• Educates staff in changes in regulatory guidelines.
• Creates, interprets and explains reports on operations data such as accuracy, scheduled events, volumes, wait times and trends.
• Responsible for continually innovating effective order management and scheduling processes through the DMAIC process.
• Develops and maintains a proactive communication matrix with identifiable problem-solving feedback loops with other directors and managers.
• Analyzes focus study trends, processes and other issues surrounding Chargemaster Referrals communicating issues with affected Department managers/directors.
• Oversight of outpatient denial management process.
• Analyzes data for Advanced Beneficiary Notice (ABN)/waivers issued, walk-ins, Chargemaster referrals worked, and Infusions managed and reports monthly to Director.
• Supervises process for checking medical necessity and insurance pre-certification/pre-determination for all infusion orders and communication approval back to Infusion Department.
• Educates staff so they are proficient in coding software to ensure proper CPT and ICD codes are used to run medical necessity checks and pre-certification/pre-determination for commercial payers.
• Along with director, functions as a third level reviewer, collaborating with HIM, Coding, and physicians to maximize Coding and Documentation Assurance.
• Manages physician query process for medical necessity along with director.
• Additional Functions Serves as a resource for physician offices regarding regulatory standards, policies and procedures for outpatient orders.
• Serves as a resource for Registration, Scheduling, and Clinical Departments for order completeness, policies and procedures for outpatient orders, medical necessity issues, and regulatory standards.
• Covers for the inpatient case manager as needed including all job requirements of the inpatient Case Manager.
• Serves and leads on hospital-wide teams for process and quality improvement initiatives.
• Program developments and management of such programs.
• Other duties as assigned.

Qualifications

Required:

• Bachelor’s degree
• Registered Nursing license issued by the State of Illinois or Licensed Clinical Social Worker in the state of Illinois (LCSW)
• Must demonstrate broad and thorough knowledge of the theories, principles and practices in a professional discipline, specialized or occupational field
• More than five up to eight years of related work experience  

#LI-MP1

#INDC

Preferred:

• Master’s degree (with the exception of LCSW)

Equal Opportunity

Northwestern Medicine is an affirmative action/equal opportunity employer 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.