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RN Case Manager
1 month ago
Job description
Position: RN Case Manager/Referral Coordinator
Status: Full-time
Location Polk Street Center - 1634 West Polk Street, Chicago, IL 60612
Who we are:
Union Health Service (UHS) is an AAAHC (Accreditation Association for Ambulatory HealthCare) accredited non-profit multi-specialty managed care plan covering approximately 48,000 Chicago area union members and their dependents since 1955. UHS has approximately 50 primary care physicians, over 70 specialist physicians and a tremendous clinical and support staff at 6 different medical facilities.
UHS is proud to be an employer that has a diverse workforce - boasting multi-language skills across the organization, merging different cultures and heritage - a proven strategy that comes with a long history of people who have stayed in the company for many years. We have an average length of service of over 12 years, above industry standard employee benefits, and eighty percent of our employees are union members.
Job Description:
Reporting to the Director of Medical Management, the RN Case Manager/Referral Coordinator provides coordination and continued monitoring of assessment, treatment planning, and follow up for UHS plan members. They review and evaluate inpatient and outpatient clinical data and serve as patient advocate for members and their families.
Responsibilities:
Function in accordance with applicable state and federal laws to ensure regulatory compliance.
Implement all case management reviews according to accepted and established criteria.
Process and sign off on referrals per department policies and procedures.
Obtain appropriate medical orders to open referrals as required.
Analyze cases referred for potential medical case management interventions.
Facilitate continued cross departmental collaboration.
Serve as a liaison between Physicians, Allied Health Providers, UHS departments, vendors, federal/state/local agencies and members to determine if proposed medical treatment plans meet contractual provisions.
Employ collaborative interventions to maximize health care outcomes.
Communicate with outside facilities to bring patients back in-network as appropriate.
Monitor inpatient stays to facilitate discharge planning including but not limited to transfer to SNF, LTAC or rehab facilities, therapy and DME needs.
Manage complex and high dollar cases to maximize benefits and ensure positive patient outcomes.
Review cases with Physician Advisor according to department protocol.
Collaborate with Providers and vendors to streamline and improve processes, as well as maintain cost effective care.
Work cross departmentally to ensure appropriate benefit determination.
Utilize outcome data to improve ongoing care management services.
Develop and sustain positive working relationships with internal and external teams.
Promote quality and efficiency in the delivery of care management services.
Other duties as assigned.
Required Qualifications:
Registered Nurse with current/active unrestricted Illinois license
3-5 years of progressive clinical experience
Working knowledge of case management
Experience processing referrals
Proficient in Electronic Medical Records (EMR) systems
Experience using MS Office (Outlook, Teams, Word, Excel)
Exceptional communication skills, verbal and written
Demonstrated ability to prioritize work demands and meet deadlines
Flexibility and willingness to assist other team members in a fast-paced environment
Skillset must include active listening, reliability, adaptability, problem solving/critical thinking, teamwork, enthusiasm, and empathy
Service oriented with an emphasis on Patient Experience
Experience and/or certification in Utilization Management, Case Management, Quality Assurance or Managed Care a plus
Job Type: Full-time
Pay: $31.41 - $54.85 per hour
Expected hours: 37.50 per week
Benefits:
403(b)
Dental insurance
Disability insurance
Employee discount
Free parking
Health insurance
Life insurance
Paid sick time
Paid time off
Parental leave
Retirement plan
Tuition reimbursement
Schedule:
Day shift
Monday to Friday
Experience:
Case management: 1 year (Preferred)
Progressive Clinical: 3 years (Required)
License/Certification:
RN License (Required)
Nursing Case Management Certification (Preferred)
Work Location: In person
