Registered Nurse Case Manager

2 weeks ago


Huntley, Illinois, United States Northwestern Memorial Healthcare Full time
Company Overview
At Northwestern Medicine, we prioritize every patient interaction, fostering a positive work environment. Our patient-first philosophy distinguishes us as a leader in the healthcare sector. As a vital member of our organization, you will contribute to our mission of enhancing healthcare delivery across the Northwestern Medicine system. We offer competitive benefits, including tuition reimbursement, loan forgiveness, 401(k) matching, and lifecycle benefits, ensuring our employees are well taken care of.

Position Overview

The Case Manager embodies the mission, vision, and values of Northwestern Medicine, adhering to the organization's Code of Ethics and Corporate Compliance Program, while complying with all relevant policies, procedures, guidelines, and regulatory standards.

The Case Manager is tasked with proactively overseeing the continuum of care for diverse patient populations from pre-admission through discharge. This role supports collaborative professional practice among all members of the care team, championing optimal clinical outcomes and efficient resource utilization, ensuring patients and families navigate their hospitalization and post-discharge processes seamlessly.

Key Responsibilities:
  • Collaborate independently with care team members to enhance healthcare plans for individual patients and populations through the development and implementation of multidisciplinary care plans and clinical pathways.
  • Facilitate regular patient care rounds and multidisciplinary discharge planning meetings to evaluate ongoing care needs, discharge requirements, and improve communication and satisfaction among the healthcare team and patients.
  • Conduct interviews with patients and family members (when appropriate) to assess age, functioning level, and connection to community services prior to hospitalization, as well as the impact of illness/accident on emotional, spiritual, and physical health.
  • Coordinate timely discharge plans to address post-hospital recovery needs, including scheduling follow-up appointments and linking patients/families to community resources.
  • Educate the patient care team on timely discharge planning, resource utilization, and care enhancement processes.
  • Work closely with the Utilization Management team to ensure responsible resource use and appropriate length of stay, maintaining knowledge of the utilization review process and its relation to discharge planning.
  • Document all patient interactions and care planning accurately, communicating with physicians to obtain necessary orders and documentation for post-hospital care.
  • Oversee the Medicare Important Message process and coordinate appeals with the Professional Review Organization as needed.
  • Communicate essential patient information to HMOs, PPOs, and other third-party payors to certify patients for services and equipment.
  • Monitor indicators such as length of stay, service delays, pathway compliance, and quality outcomes, collaborating with the healthcare team to identify improvement opportunities.
  • Stay informed on industry best practices and maintain a professional network for idea exchange and benchmarking.
  • Support team members as needed, contributing to team goals by fostering collaboration and recognizing the contributions of others.
  • Adapt to working in various units or campuses within the Northwestern Medicine Healthcare System as required to meet patient needs.
  • Understand the principles of growth and development across the lifespan, assessing data reflective of patient status and identifying age-specific needs.
Qualifications

Required:
  • Registered Nurse with Illinois Licensure
  • CPR certification
  • 2-3 years of clinical nursing experience
  • Physical capability to perform required functions.
Preferred:
  • Bachelor of Science in Nursing (BSN)
  • 2 to 5 years of relevant experience
  • ACM or CCM certification
  • Familiarity with insurance guidelines, CMS requirements, and other payer regulations.
Additional Information
Northwestern Medicine is an affirmative action/equal opportunity employer, committed to a diverse workforce and does not discriminate in hiring or employment based on age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation, or any other protected status.

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