Case Manager Care Coordination Days Registry

Northwestern Memorial Healthcare • Winfield, IL

3d

About The Position

The Case Manager IHR 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.

Requirements

• Bachelor's degree in Nursing with current RN license in the state of Illinois OR Master's degree in Social Work with current LSW or LCSW license in the state of Illinois.

Nice To Haves

• Previous experience with Case Management and/or Discharge Planning in a hospital setting.
• Previous experience in a rehabilitation setting.

Responsibilities

• Handles caseload of patients as determined by manager.
• Forwards assessments and clinical data to payers and external providers to facilitate transitions and payment.
• Communicates team conference and POC recommendations to patient and family and to third parties as indicated.
• Assists with facilitation of team conference to ensure that patient continues to meet LOC criteria and is progressing toward discharge goals in conjunction with interdisciplinary team.
• Works with interdisciplinary team on ensuring procurement of discharge needs for patient in terms of DME, clinical services and ongoing care to support a safe transition to an appropriate LOC.
• Facilitates family training as needed in order to support a safe transition to the next LOC.
• Assesses need for and provides referrals to community resources to support the patient safely in the community setting.
• Coordinates with patient/financial services and admissions to ensure smooth transitions between levels of care and manage concurrent denials.
• Provides ongoing education to interdisciplinary team on patients insurance benefits and status of LOS approval.
• Requests authorization for continued stay from payers as recommended by interdisciplinary team through concurrent review process.
• Coordinates appeals on any concurrent denials of requests for continued stay.
• Reviews patients progress and medical necessity for continued stay against protocol and benchmarks and communicates with attending physician and team.
• Monitors and communicates resource utilization with attending physician.
• Identifies variances from established benchmarks on cost/outcome/LOS and notify physician and team.
• Obtains authorization as required from payer for any special services or procedures.
• Case Managers in pediatrics assist with managing referrals for IRF and outpatient services as well as assists with referral development objectives.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees