Case Manager RN-Care Coordination Full-time Days

The Case Manager RN   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:

• Develops individualized treatment plans for patients in collaboration with the patient their family and
• Coordinates and leads care conferences on patients with length of stays greater than 7 days.
• Documents unusual occurrences and patient relations issues; makes appropriate referrals to risk management infection control and quality departments.
• Assesses patient and family needs for appropriate discharge services.
• Coordinates transfer to appropriate level of care such as skilled care rehabilitation custodial and home health care.
• Documents discharge planning on the interdisciplinary plan of care in progress notes and education record.
• Maintains current knowledge of resources available in the community to support a continuum of effective services for the patient.
• Delivers notice of Medicare discharge appeal rights within the appropriate time frame.
• Assists physician in assigning admission status.
• Performs medical record review to assess for appropriateness of admissions and continued hospital stay.
• Monitors avoidable days and recommends change in services or processes.
• Educates staff on CPG/Standing Orders/Protocols that complement industry standards to reduce length of stay and resource consumption while maintaining quality of care.
• Ensures compliance with managed care contracts and length of stay targets while maintaining quality of care.
• Develops and educates staff on CPG/Standing Orders/Protocols that complement industry standards to reduce length of stay and resource consumption while maintaining quality of care.
• Distributes hospital issued non coverage notices.
• Monitors documentation of an appropriate diagnosis for outpatient/observation testing and queries physicians/APPs as needed following AHIMA guidelines.
• Responds to requests by patient financial services for appeal assistance.
• Supports Denials Lead RN on Appeals insurance denials for medical necessity for inpatient and outpatient services.
• Completes documentation worksheet.
• Queries physician for clarification or missing documentation.
• Performs chart audits for documentation compliance with CMS standards.
• Obtains appropriate documentation to comply with core measure standards.

Qualifications :

Required

• Registered Nursing license issued by the State of Illinois.
• Bachelors of Science Nursing
• 3 or more years of related clinical experience 

Preferred

• Masters of Science Nursing
• Membership in Professional Nursing Organization
• Certification in Case Management (ACM)

Additional Information :

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. 

Remote Work :

No

Employment Type :

Full-time