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Utilization Review Bed Placement Case Manager RN-Part-time Nights
2 months ago
Benefits
* $10,000 Tuition Reimbursement per year ($5,700 part-time)
* $10,000 Student Loan Repayment ($5,000 part-time)
* $1,000 Professional Development per year ($500 part-time)
* $250 Wellbeing Fund per year($125 for part-time)
* Matching 401(k)
* Excellent medical, dental and vision coverage
* Life insurance
* Annual Employee Salary Increase and Incentive Bonus
* Paid time off and Holiday pay
Pay Starting at: $38.00+ per hour based on experience
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 works M-F 8pm to 12am, with an every third weekend commitment. *
The 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:
* Develops and implements individualized treatment plans for patients, in collaboration with the patient, their family and provider.
* Coordinates care and services for assigned patients for an episode of illness or treatment in collaboration with the patient, family, physician, patient care team, and payers.
* Utilizes advanced clinical skills to facilitate the provision of care which includes the assessment, planning, intervention and evaluation principles of the nursing process.
* Maintains current knowledge of resources available in the community to support a continuum of effective services for the patient.
* Promotes and evaluates the effective utilization of resources using current clinical knowledge, awareness of community services, and assuming a leadership role with the patient care team to achieve optimal clinical and resource outcomes.
* Plans and leads care conferences on patients with length of stays greater than 7 days or as needed.
* 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/1-day stays, readmits in 30 days, Medicare and diagnosis related criteria.
* Assesses patient and family needs for appropriate discharge services.
* Advocates for the patient and family throughout the entire episode of care.
* Coordinates transfer to appropriate level of care such as skilled care, rehabilitation, long term acute care, custodial, hospice and/or home health care.
* Documents discharge planning on the interdisciplinary plan of care, in progress notes and education record when applicable.
* Delivers notice of Medicare discharge appeal rights within the appropriate time frame.
* Delivers Observation letter notification when applicable.
* Distributes hospital issued non coverage notices.
* Consults with physicians in assigning admission level of care status and uses external physician advisory group as needed.
* Stays up-to-date on Medicare rules and regulations for hospital and post hospital services.
* Performs medical record review to assess for appropriateness of admissions and continued hospital stay.
* Monitors and documents avoidable days and recommends change in services or processes.
* Ensures compliance with managed care contracts and length of stay targets while maintaining quality of care.
* Develops and educates staff on clinical practice guidelines/Standing Orders/Protocols that complement industry standards to reduce 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.
* Responds to requests by patient financial services for appeal assistance.
* Appeals insurance denials for medical necessity for inpatient and outpatient services.
AA/EOE.
Qualifications
Required:
* Registered Nursing license issued by the State of Illinois.
* Bachelors of Science Nursing.
* 5 or more years of related clinical experience.
Preferred:
* Masters of Science Nursing.
* Membership in Professional Nursing Organization.
* Certification in Case Management (ACM).
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.
