Case Manager RN-Utilization Review Full Time Mid Shift
Case Manager RN-Utilization Review Full Time Mid Shift
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
**This is a full time salaried position located at Lake Forest Hospital. This role in an onsite position. **
The Case Manager RN UR / Bed Planner Night Shift reflects the mission vision and values of NM adheres to the organizations 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/1day stays readmits in 30 days Medicare and diagnosis related criteria.
- Consults with physicians in assigning admission level of care status.
- Stays uptodate 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.
Qualifications :
Required:
- Registered Nursing license issued by the State of Illinois.
- Bachelors of Science Nursing
- At least two to five years 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
- Masters of Science Nursing
- Membership in Professional Nursing Organization
- Certification in Case Management (ACM)
Additional Information :
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.
If we offer you a job we will perform a background check that includes a review of any criminal convictions. A conviction does not disqualify you from employment at Northwestern Medicine. We consider this on a casebycase basis and follow all state and federal guidelines.
Benefits
We offer a wide range of benefits that provide employees with tools and resources to improve their physical emotional and financial wellbeing while providing protection for unexpected life events. Please visit our Benefits section to learn more.
Remote Work :
No
Employment Type :
Fulltime
Employment Type
Full-time
