Nurse Case Manager Care Coordination Part Time Days

Northwestern Medicine; Winfield (IL); On-site; USD 42,000 - 62,000; Part time

Benefits offered by this job

Benefits package

Job summary

Northwestern Medicine in Illinois is seeking a part-time Nurse Case Manager (0.7 FTE) to coordinate care from admission through discharge, ensuring timely, cost-effective pathways and appropriate levels of care. You will collaborate with physicians, nursing staff, and other professionals to plan and evaluate care, expedite approvals, and smooth handoffs to post-acute providers.

Requires an IL RN license, BSN (or equivalent) and at least one year of acute-care case management experience;

Qualifications

• Registered Nurse with Illinois license required.
• BSN required for hires after 01/01/2011.
• At least one year of case management experience in an acute hospital setting.

Responsibilities

• Assess, plan, implement, and evaluate the care plan with patient/family.
• Collaborate with physicians and the multidisciplinary team on admission status and resource use.
• Refer cases to patient financial services, peer review, risk management.
• Coordinate bed placement and discharge planning with care teams to ensure safety and continuity.
• Participate in rounds and care conferences to identify needs and barriers.

Skills

Case management experience

Collaboration

Communication skills

Bilingual

Education

Bachelor of Science in Nursing (BSN)

Job description

Description

Days Part time, 0.7 FTE,hours are 8-4:40. One weekend every 7 weeks and one holiday per year.

TheNurse Case Managerreflects 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.

• Assists in coordinating the patient's stay from admission through discharge. Assists to expedite medically appropriate, cost-effective care. Helps to ensure patient is at the right level and site of care, and the patient moves along the continuum of care in a safe and timely manner.

Responsibilities:

• In collaboration with the patient/family, and members of the health care team, assesses, plans, implements, and evaluates the plan of care and the patient's response to treatment.
• Continually proactive in collaborating and educating physicians and multidisciplinary team in appropriateness of admission, continued stay, utilization of resources and expected LOS.
• Refers appropriate cases to patient financial services, peer review, patient relations, risk management.
• Collaborates with physicians and other health care team members to clarify admission status and plan of care.
• Utilizes all available tools and resources to gain better and complete picture of clinical assessment of the patient: notifies physicians and staff of concerns/variations.
• Relays pertinent information to appropriate care team members relative to admission, continuum of care and concerns related to discharge.
• Ensures that the interdisciplinary care plan and the discharge plan are comprehensive and consistent with the patient's clinical course, continuing care needs, and coordinated with covered services as available.
• Assesses and reassesses the patient for on-going care needs with knowledge of high-risk criteria and initiates referrals to the appropriate resources in a timely manner to progress toward the discharge plan.
• Participates in rounds and complex patient care conferences as indicated, identifying needs, barriers, and action plans.
• Performs utilization management activities of all inpatients and observation patients by applying approved criteria. Notify physician advisor of any outlier cases.
• Provides timely and thorough reviews to third party payers as requested or required. Experiences minimal denials based on lack of medical necessity.
• Has a good working knowledge base of available and diverse extended care providers for general population served. Asks co-workers for references for unfamiliar cases.
• Researches patient insurance plan in order to offer in-network providers of care and allow patient to make informed decisions.
• Partners with the nursing staff and physicians to convey accurate and timely information to post-acute care providers to encourage a smooth hand-off and create a seamless and safe discharge to the next continuum of care.
• Partners with the care delivery team to identify proactively and coordinate any educational needs for the patient and family.
• Ensures the patient is at the most appropriate level of care for the expressed severity of illness and level of services required. Applies National Guidelines and clear communication with physicians.
• Collaborates with physicians and other health care team members to clarify admission status and plan of care.
• Coordinates appropriate bed placement for patients with Patient care services, collaborating on location, staffing etc.
• Queries the admitting physician for additional information as needed to meet medical necessity for admission or appropriate level of care. Refers cases to physician advisor for any outlier cases.
• Coordinates patient activity and flow or movement between levels of care. Identifies potential throughput barriers and acts proactively to inform and alert upper management of anticipated delays.
• Reviews clinical against Milliman criteria to help determine patient class and level of care needed. Confers with MD to discuss clinical and appropriate level of care when needed.

Qualifications

Required:

• Bachelors of Science in Nursing (required for hires after 01/01/2011)
• Registered Nurse in the state of Illinois
• One year of case management experience in an acute hospital setting

Preferred:

• Two years’ experience in utilization review
• Case management certification
• Prior experience in case management or insurance setting.
• Bilingual

Equal Opportunity

Northwestern Medicine is an equal opportunity employer (disability, VETS) and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.

Background Check

Northwestern Medicine conducts a background check 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 form that gives Northwestern Medicine permission to run the background check. Results are evaluated on a case-by-case basis, and we follow all local, state, and federal laws, including the Illinois Health Care Worker Background Check Act.

Artificial Intelligence Disclosure

Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person.

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.

NorthwesternMedicine Career Page

https://jobs.nm.org/benefits

Please refer to the Benefits Eligibility by Employment Classification to determine benefits eligibility for job postings.

If sign-on bonus is included in a job posting eligibility is as followed: Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign-on bonus. Exception: New graduate internal employees seeking their first licensed clinical position as a Registered Nurse at NM may be eligible.