CLINICAL CASE MANAGER - CORE - GRANT FUNDED

Cook County•Chicago, IL

17h•$48 - $65•Onsite

About The Position

Uses knowledge of disease processes, health care delivery and financing to support effective, efficient inpatient care while acknowledging patient/family preferences, treatment requirements and self-care capabilities to determine and appropriate discharge plan. These and all other activities are performed in compliance with all Cook County Health & Hospitals System (CCHHS) policies and procedures and in collaboration, as appropriate, with physicians, nurses, therapy department members, social workers, and insurance company representatives. This is a grant-funded position. The (Grant 2025 CCH HIV SVCS-POP CENT H H-HRSA) grant will expire on 07-31-2026 with the potential to be renewed. Job Summary Uses knowledge of disease processes, health care delivery and financing to support effective, efficient outpatient care while acknowledging patient/family preferences, treatment requirements and self-care capabilities to determine and appropriate discharge plan. These and all other activities are performed in compliance with all Cook County Health & Hospitals System (CCHHS) policies and procedures and in collaboration, as appropriate, with physicians, nurses, therapy department members, social workers, and insurance company representatives.

Requirements

Registered Professional Nurse in the State of Illinois.
Three (3) years of experience as a Registered Professional Nurse in any of the following steps: outpatient care, or patient centered medical home

Nice To Haves

Bachelors of Science in Nursing from an accredited institution.
Previous experience with administering medical necessity criteria.
Previous care management experience for patients with multiple chronic disease and acute illness.
Accredited Case Manager (ACM) or Certified Case Manager (CCM).
Bilingual skills in either English/Spanish or English/Polish.
Knowledge of managed care and impact on patient care priorities.
Knowledge of managed care, Medicare and Medicaid.
Knowledge of the admission review process with the ability to conduct patient status assessments.
Excellent interpersonal skills with the ability to work with a culturally diverse patient population and collaboratively with physicians, nurses, therapy department members, social workers and insurance company representatives.
Ability to adopt another’s point of view to facilitate patient centered goal setting.
Ability to streamline workflows.
Ability to make sound judgments.
Ability to prioritize, plan, and organize projects and tasks.
Ability to multi-task, manage multiple or competing priorities, and meet deadlines in a fast paced and stressful environment.
Attention to detail.
Basic Office Suite skills to include Outlook, Excel and Word.
Strong initiative.

Responsibilities

Performs an admission review that includes at a minimum the following: an assessment of patient status e.g. outpatient vs. observation; a determination of whether the patient’s condition meets medical necessity criteria for outpatient care of if significant barriers exist.
Validates pay source and physician orders if necessary.
Collaborates with social work colleague to determine approach to discharge planning and which discipline is most appropriate to lead.
Calls in review on all cases that require review of whose payer status has not changed. Notifies manager if reviews are incomplete or days are denied.
Reassesses patient as clinically indicated or required by payer.
Documents authorizations and case notes according to departmental policy.
Presents concise, comprehensive review of assigned patients during rounding.
Identifies concerns regarding quality and risks. Reports same to supervisor.
Interacts with physicians regarding medical necessity, identification of appropriate discharge, disposition, reasonable alternatives or information necessary to support discharge planning.
Participates in Quality Improvement (QI) activities, pilots, workgroups and other activities to improve departmental operations.
Managers the Antiretroviral Pregnancy registry & data entry in collaboration with OB/Gyne attendings
Coordination of care for External Referrals