ED Utilization Mgmt RN Care Coordination Full Time Evenings

The salary range for this position is $38.50 - $61.60 (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

This position is in the ED: 6:00pm -2:00AM. Monday through Friday.  No weekends /holidays. This is not a remote position.  

The Utilization Management 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.

The Utilization Management nurse role is to ensure that health care services are administered with quality, cost efficiency, and within compliance by continuously reviewing the EMR and collaborating with the health care team.

Responsibilities:

• Concurrent review of patients clinical information for efficiency and correct level of care and admission status
• Interface with payers concurrently and after discharge to obtain authorization
• Concurrent denials management
• Collaborates with the denials management team
• Ongoing review of pre-certification requests for medical necessity
• Monitor the activities of clinical and non-clinical staff
• Collaborates with the health care team and payers to assist with coordinating patients discharge planning needs
• Employ effective use of knowledge, critical thinking and skills
• Work in an intensive, fast-paced environment with minimal supervision
• Ability to stay organized and interact well with others in any situation
• Provide updates to Director of Utilization Management for review

Qualifications

Required:

• Bachelor's degree in Nursing
• State licensure as a Registered Nurse (RN)

Preferred:

• Master's degree
• Minimum 2 years of prior experience in Utilization Management
• Utilization Management or Case Management certification

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.