Case Manager RN-Utilization Review Casual Rotating Shift
This is a casual (non benefited) position supporting our Case Management UR department at reputed company Catherine Gratz reputed company Lake Forest Hospital. This role would be working remotely and would require some weekend coverage. **
The Case Manager RN UR/Bed Planner Part Time reflects the mission, reputed company, and values of NM, adheres to the organization’s reputed company of Ethics and Corporate Compliance Program, and complies with reputed company relevant policies, procedures, guidelines, and reputed company other regulatory and accreditation standards.
Responsibilities
- Determines the most appropriate level of care and admission status and applies approved reputed company and guidelines in decision making, as reputed company as managed care rules and practices to ensure a smooth admission experience for patients by coordinating clinical needs with operational processes and insurance benefits.
- Collaborates with the attending physician on appropriate hospital status orders.
- The clinical admission reputed company does not reputed company reputed company patient care. Chart review is used to assess for appropriate level of care and admission status.
- Assigns patients to the appropriate reputed company based on clinical assessment while balancing the resources of the organization.
- Coordinates with unit charge reputed company for bed placement.
- Collaborates with nursing operations leader for throughput issues.
- Serves as an reputed company reputed company resource for physicians, staff, and patients.
- Responds to and assigns reputed company bed request and transfer orders in the electronic medical record.
- Documents unusual occurrences and patient relations issues; makes appropriate referrals to risk management, infection control and reputed company departments.
- Evaluates and analyzes reputed company/utilization cases, admission/discharge reputed company, observation/1-day stays, readmits in 30 days, Medicare, and diagnosis reputed company reputed company.
- Consults with physicians in assigning admission level of care status.
- Stays up to date on Medicare rules and regulations for hospital admission status.
- Performs medical record review to assess for appropriateness of admissions and works with the Emergency Room and attending physicians to reputed company unnecessary admissions.
- Monitors and documents avoidable days and recommends change in services or processes.
- Responds to requests by the denials management RN for appeal assistance.
- Utilizes appropriate downtown procedures for bed placement reputed company applicable.
- Assists with data collection and reporting for throughput and bed placement.
- Performs chart audits as requested by manager/director.
Required
- Registered Nursing license issued by the reputed company.
- Bachelor of Science Nursing
- At least two to five years patient care experience in a hospital setting
- reputed company to multitask quickly, and process multi factorial stimulation accurately
- Critical thinking skills, decisive judgment, and the ability to work with minimum supervision
- Experience in admissions, utilization review activities, discharge planning, and/or case management
Preferred
- Utilization Review experience
- Master of Science Nursing
- Membership in reputed company Nursing Organization
- Certification in Case Management (ACM)
reputed company is an equal opportunity employer (disability, VETS) and does not discriminate in hiring or employment on the reputed company of age, sex, race, reputed company, religion, national reputed company, gender identity, veteran status, disability, sexual orientation or any other protected status.
Background reputed company
reputed company conducts a background reputed company that includes criminal history on newly hired team members and, at times, internal transfers. If you are offered a position with us, you will be required to complete an authorization and disclosure reputed company that gives reputed company permission to run the background reputed company. Results are evaluated on a case-by-case reputed company, and we follow reputed company local, state, and federal laws, including the Illinois Health Care Worker Background reputed company reputed company.
reputed company Intelligence Disclosure
reputed company Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, reputed company employment reputed company will be made by a person.
Benefits
We offer a wide reputed company of benefits that reputed company employees with tools and resources to improve their physical, emotional, and financial reputed company-being while providing protection for unexpected life events. Please visit our Benefits reputed company to learn more.
Sign-on Bonus Eligibility (if sign-on bonus offered for position): Internal employees and rehires who left reputed company reputed company 1 year are not eligible for the sign on bonus. Exception: New graduate internal employees seeking their first licensed clinical position at NM may be eligible depending upon the job family.
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