RN Care Manager: Care Coordination & Reimbursement

Endeavor Health; Evanston (IL); On-site; USD 55,000 - 87,000; Full time

Benefits offered by this job

Premium pay for eligible employees

Career Pathways for growth

Medical, Dental, and Vision options

Tuition Reimbursement

Free Parking

Job summary

Endeavor Health in Evanston, IL is seeking an RN Care Manager for a full-time role (40 hours/week) with hours Monday-Friday and rotating weekends including holiday coverage. The position requires IL nursing licensure, a BSN, and at least 2 years of clinical nursing experience, with preference for utilization management or chronic disease management experience.

Responsibilities include facilitating payor authorizations, coordinating care across the continuum, and ensuring accurate documentation

Qualifications

• IL nursing license required.
• Bachelor's degree in Nursing required; NLN-accredited program preferred.
• Certification in case management beneficial; BLS/CPR for Healthcare Providers (AHA) or CPR/AED for Professional Rescuers (ARC).
• Minimum of 2 years clinical nursing experience; Utilization Management or chronic disease management preferred.
• Experience with EMR platform; knowledge of InterQual or MCG criteria preferred.

Responsibilities

• Facilitates payor authorization processes and ensures correct patient type.
• Collaborates across the continuum to remove barriers to timely and efficient care and reimbursement.
• Works with the CDI team to ensure documentation reflects severity of illness and intensity of service.
• Maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to progress care.
• Identifies and resolves delays to discharge to optimize length of stay and cost effectiveness.
• Seeks consultations from required disciplines to expedite care and facilitate discharge.
• Monitors patient progress to ensure planned care is high quality and patient-focused.

Skills

Nursing

Utilization Management

Chronic Disease Management

Education

Bachelor's degree in Nursing

IL Nursing Licensure

NLN-accredited nursing program (preferred)

Tools

EMR Platform

InterQual Criteria

Job description

Endeavor Health in Evanston, IL is seeking an RN Care Manager for a full-time role (40 hours/week) with hours Monday-Friday and rotating weekends including holiday coverage. The position requires IL nursing licensure, a BSN, and at least 2 years of clinical nursing experience, with preference for utilization management or chronic disease management experience.

Responsibilities include facilitating payor authorizations, coordinating care across the continuum, and ensuring accurate documentation